Кардиоваскулярная терапия и профилактика (Oct 2006)
Antiaggregant influence on platelet aggregation in patients with acute coronary syndrome without ST segment elevation
Abstract
Aim. To study antiaggregant therapy effects in patients with instable angina (UA) and non-Q wave myocardial infarction (non-Q MI). Material and methods. This randomized, open, comparative study included 78 patients with Class IIID UA and non-Q MI. Group I (n=17) did not receive any antiaggregants; Group II (n=26) was administered aspirin (250 mg/d at admission, then 125 mg/d); Group III (n=17) received cardiomagnil (150 mg/d, then 75 mg/d); Group IV (n=11) was treated with clopidogrel (75 mg/d) and cardiomagnil (75 mg/d) combination. ADP and adrenalininduced platelet aggregation (PA) was measured with a laser platelet aggregation analyzer 230-LA. All participants received subcutaneous fraxiparin (86 IU/kg every 12 hours). Results. In Group I, hyperPA was observed. In Group II, 6 patients out of 26 demonstrated aspirin resistance. In aspirin-sensitive participants, ADP-induced PA decreased only slightly, and adrenalin-induced PA was significantly suppressed. In Group III, all 17 patients were aspirin-sensitive. PA parameters were similar to those in Group II (effective treatment). Clopidogrel significantly reduced ADP-induced PA only. Clopidogrel and cardiomagnil combination was the most effective option: ADP and adrenaline-induced PA was halved, compared to control parameters. Conclusion. In ACS syndrome patients without ST elevation, antiaggregant therapy control by platelet function monitoring provides an opportunity for choosing the most effective, individualized treatment. Comparative antiaggregant effectiveness was measured during fraxiparin therapy.
