Poređenje farmakodinamskih osobina tri različita preparata aspirina kod bolesnika sa stabilnom koronarnom bolešću
Sažetak
Uvod/Cilj. Agregacija trombocita, kao laboratorijski test za procenu funkcije trombocita, je od posebnog značaja za optimalno vođenje antitrombocitne terapije i izdvajanje bolesnika koji pokazuju suboptimalni odgovor na primenu antitrombocitnih lekova, kao što su aspirin i klopidogrel. Cilj rada bio je odrediti stepen inhibicije agregacije trombocita metodom impedantne agregometrije kod bolesnika koji su uzimali različite preparate acetilsalicilne kiseline (ASA) u dozi od 100 mg dnevno. Metode. Ispitivanjem je obuhvaćeno 215 bolesnika (110 muškaraca i 105 žena), koji su nakon infarkta miokarda sa naknadnom revaskularizacijom uzimali jedan od tri različita preparata ASA, pojedinačno ili u kombinaciji sa klopidogrelom. Od ukupnog broja, 89 bolesnika je uzimaloAspirin protect® (Bayer, Nemačka) – Grupa 1, Cardiopirin® (GL Pharma GMBH, Austrija) je uzimalo 66 bolesnika– Grupa 2, dok je 60 bolesnika primalo Andol® (Pliva, Hrvatska) – Grupa 3. Grupe su bile jednake u zastupljenosti faktora koji mogu biti od uticaja na agregaciju trombocita (starost, pol, pušenje, diabetes, uzimanje drugih lekova). Funkcija trombocita merena je na impedantnom agregometru Multiplate (Multiplate Platelet Function Analyzer, Roche) iz uzoraka krvi sa heparinom, korišćenjem agregacije trombocita aktiviranih arohidonskom kiselinom (ASPI) i trombinom (TRAP) [rezultati su bili izraženi kroz površinu ispod agregacione krivulje u periodu ispitivanja (AU*min)]. Rezultati. Ustanovljena je statistički značajna razlika u efikasnosti različitih preparata ASA (χKW2 = 46,279; p < 0,001), kako kod bolesnika koji su na pojedinačnoj (χKW2 = 26,344; p < 0,001), tako i onih na dvojnoj terapiji (χKW2 = 23,498; p < 0,001). Bolesnici koji su uzimali Aspirin protect® su imali značajno bolju antiagregacionu efikasnost leka u poređenju sa bolesnicima koji su uzimali Cardiopirin® (Z = 5,472; p < 0,001) i Andol® (Z = 5,387; p = 0,022). Postojao je smanjeni efekat svih preparata ASA kod pušača, dok su bolesnici koji su uzimali Aspirin protect® imali 10,5 puta veću verovatnoću da budu responderi. Zaključak. Različiti preparati acetilsalicilne kiseline posmatrani u ovom ispitivanju pokazuju laboratorijski značajno različitu efikasnost na funkciju trombocita merenu metodom impedantne agregometrije.
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