cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2143Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONРезистентность к аспирину у больных с острым коронарным синдромом. Часть 1Aspirin resistance in patients with acute coronary syndrome. Part 1ФроловаН. С.FrolovaN. S.

врач палаты интенсивной терапии отдела неотложной кардиологии

Frolik78@mail.ruШахновичР. М.ShakhnovichR. M.

с.н.с. отдела неотложной кардиологии

КазначееваЕ. М.KaznacheevaE. M.

с.н.с. лаборатории иммунологии

СироткинаО. В.SirotkinaO. V.

с.н.с. лаборатории молекулярной генетики человека

ДобровольскийА. Б.DobrovolskyA. B.

в.н.с. лаборатории клинических проблем атеротромбоза

Институт клинической кардиологии ФГУ РКНПК РосмедтехнологийResearch Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical ComplexПетербургский институт ядерной физики им. Б.П. Константинова РАН. Санкт-ПетербургB.P. Konstantinov St. Petersburg Institute of Nuclear Physics, Russian Academy of Sciences. St. Petersburg201020122010964046Copyright © Фролова Н.С., Шахнович Р.М., Казначеева Е.М., Сироткина О.В., Добровольский А.Б., 20102010Фролова Н.С., Шахнович Р.М., Казначеева Е.М., Сироткина О.В., Добровольский А.Б.Frolova N.S., Shakhnovich R.M., Kaznacheeva E.M., Sirotkina O.V., Dobrovolsky A.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2143

Цель. Определить частоту развития резистентности к аспирину у больных с острым коронарным синдромом (ОКС), клинические особенности, возможности преодоления и влияние на прогноз. Материал и методы. В исследование включены: 51 больной с ОКС с подъемом сегмента ST (ОКСпST) и 49 c ОКС без подъема сегмента ST (ОКСбпST), получавшие стандартную дозу аспирина 100 мг/сут. Измерение агрегации тромбоцитов (АТ) проводилось при помощи лазерного анализатора, в качестве индуктора использована арахидоновая кислота (АК) 0,5 мг/дл. Критерий резистентности: АТ с АК ≥ 20 % на 7 день лечения аспирином. Результаты. 11 % больных, принимавших аспирин в стандартной дозе 100 мг/сут., были резистентны к аспирину. Большинство из них – среди больных с ОКСпST, в связи с чем проанализирована именно эта группа (гр.) пациентов. Существенных различий в гр. резистентных и чувствительных к аспирину больных по основным клиническим характеристикам не выявлено. После выполнения пробы с аспирином in vitro, для выявления фармакокинетического типа резистентности, доза аспирина была увеличена до 300 мг/сут. В качестве гр. сравнения представлены 10 больных с ОКСпST, которые продолжали прием аспирина в дозе 100 мг/сут. Через 30 сут. в обеих гр. резистентных больных отмечено достоверное снижение АТ. Таким образом, увеличение дозы аспирина не влияло на динамику АТ. Прогноз у больных, резистентных к аспирину был несколько хуже, чем у чувствительных к нему. Заключение. Резистентность к аспирину чаще встречается у больных с ОКСпST. К 30 сут. наблюдалось достоверное снижение АТ. Увеличение дозы до 300 мг/сут. не меняло характер динамики АТ.

Aim. To evaluate the prevalence of aspirin resistance, its clinical features, potential solutions, and prognostic role in patients with acute coronary syndrome (ACS). Material and methods. The study included 51 patients with ACS and ST segment elevation (STEACS) and 49 ACS patients without ST segment elevation (non-STEACS). All participants received aspirin in a standard dose of 100 mg/d. Platelet aggregation (PA) was measured with a laser assay method and arachidonic acid (0,5 mg/dl) as an inductor. Aspirin resistance was diagnosed if PA was at least 20% at Day 7 of aspirin treatment. Results. Aspirin resistance was observed in 11% of the patients receiving aspirin in a standard dose of 100 mg/d. The majority of aspirin-resistant patients had STEACS, therefore, the data for this group were analysed in detail. Major clinical characteristics of aspirin-resistant and aspirin-responding patients were similar. After the in vitro test with aspirin, to determine the pharmacokinetic type of aspirin resistance, the medication dose was increased to 300 mg/d. The comparison group included 10 patients with STEACS, receiving aspirin in the dose of 100 mg/d. Thirty days later, PA was significantly reduced in both aspirin-resistant groups, therefore, the aspirin dose increase did not affect PA dynamics. In aspirin-resistant patients, prognosis was slightly worse than in their aspirinresponding peers. Conclusion. Aspirin resistance was more prevalent in STEACS patients. By Day 30, PA was substantially reduced. Increasing aspirin dose to 300 mg/d did not affect PA dynamics.

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The authors declare that there are no conflicts of interest present.