Interference Of Cardiotonic Pill For Aspirin Resistance: A Clinical Trial

Aspirin (acetylsalicylic acid, ASA) reduces the activation and aggregation of platelets by irreversibly acetylating cyclooxygenase-1 (COX-1), and thereby reduces thromboxane A2 produced by platelets. Widespread use of low dose aspirin(75—150mg per day) has reduced adverse cardiovascular events significantly. However, because the existence of aspirin resistance(AR), a number of patients don't get much benefit from aspirin. Our objective is to find out the prevalence, epidemiologic feature and risk factors of aspirin resistance, and to investigate the effect of Cardiotonic Pill in aspirin resistance.Methods 106 hospitalized patients(age 35-80, average 57.03±13.40), who intake aspirin 100 mg per day for at least 1 week were enrolled into our trial. 30 patients with Aspirin Resistance and Aspirin Semiresponders (ASR) were selected according to platelet aggregation, and they were randomized to three groups: Aspirin plus Cardiotonic Pill, Cardiotonic Pill only, Aspirin only. Platelet aggregation was reevaluated in two weeks.Results AR was found in 6 patients (5.7%), AR and ASR were found in 30 patients(28.3%), The prevalence of AR, AR and ASR were similar in male and female. The level of blood glucose (7.85±6.246 vs 5.59±1.250 mmol/L, P = 0.007) and AST(49.0±59.49 vs 27.8±23.66 U/L, P=0.037) was higher in AR, compared with Aspirin sensitive patients. There were more diabetes mellitus(P=0.030) and lipid disorder(P=0.020) patients in AR and ASR, compared with Aspirin sensitive patients. Logistic regression revealed that the risk of AR and ASR was 3.236 times (95%CI 0.988～10.596, P = 0.052) in diabetes mellitus compared with non- diabetes mellitus, and 3.985 times (95%CI 0.973～16.330, P = 0.055) in lipid disorders compared with non-lipid disorders, but both did not have statistic significance. Adenosine diphosphate (ADP)-induced platelet aggregation of group aspirin plus Cardiotonic Pill, Cardiotonic Pill decreased 10.36%(P=0.010), 5.39%(P = 0.042)respectively after interference, there was no significant change in group aspirin. Arachidonic acid (AA) -induced platelet aggregation of group aspirin plus Cardiotonic Pill, Cardiotonic Pill decreased 11.74% (P =0.000) , 6.70% (P = 0.045) respectively, there was no significant change in group aspirin. Group comparison revealed that platelet aggregation has no significant difference in all groups before interference, but ADP-induced platelet aggregation in group aspirin plus Cardiotonic Pill was lower than group Aspirin significantly. ADP-induced platelet aggregation in group Cardiotonic Pill, AA-induced platelet aggregation in group aspirin plus Cardiotonic Pill was lower than group aspirin after interference.Conclusion The prevalence of AR is 5.7%, total prevalence of AR and ASR is 28.3%. The prevalence of AR, AR and ASR were similar in male and female. Diabetes mellitus and lipid disorder might be risk factors for AR and ASR. Cardiotonic Pill can improve platelet sensitivity to Aspirin, and has synergistic anti-platelet effect, could be administered to interfere aspirin resistance effectively.