阿司匹林抵抗课件.pptVIP

Introduction to Aspirin Resistance. Aspirin History First synthesized in pure form by Felix Hoffman of Friedr. Bayer Co. in 1897. Aspirin History Due to problems with the original Aspirin powder being counterfeited, it became the first pharmaceutical agent ever sold in pill form in early 1900’s. First pill in USA was 5 grains (~325 mg). Metabolic Pathways ofArachadonic Acid Aspirin in Acute Myocardial Infarction: ISIS-2 Randomized Trials of Aspirin in PTCA What is “Aspirin Resistance?” Inability of ASA to prevent treated patients from having thrombotic events. Inability of ASA therapy to prolong bleeding time. Inability of treatment with ASA to prevent thromboxane biosynthesis. Inability of ASA to achieve a pre-defined effect on an ex vivo or in vitro measure of platelet function. Inter-Individual Variability in Response to Aspirin Interpatient Variability in Aspirin Response - Bleeding Time Aspirin Responsiveness and Clinical Outcome Thromboxane Biosynthesis on Aspirin and CV Events Aspirin Responsiveness By PFA-100 and Aggregometry Clinical Outcomes: Aspirin Responsive-ness by Aggregometry And PFA-100 Possible Mechanisms for Variability in Response to Aspirin Decreased bioavailability Non-compliance Concomitant NSAIDs Platelet function Accelerated platelet turnover Increased platelet COX-2 Platelet Receptor Polymorphisms Other factors Metabolic Pathways of Arachadonic Acid PlA2 Polymorphism and Aspirin Resistance Aspirin Resistance: Role of COX-2 ? Conclusions Every study that has ever evaluated individual responsiveness to ASA has found marked variability. Most studies have been able to correlate this variability with a clinically significant increase in thrombotic events. The ability to identify the substantial proportion of patients who are unable to achieve an adequate response to ASA has the potential to dramatically improve their antithrombotic regimen and with it, long-term outcomes. * * (From the German acetylspirsaure + chemical suffix – in)