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Model based on single-nucleotide polymorphism to discriminate aspirin resistance patients.
- Source :
-
Stroke and vascular neurology [Stroke Vasc Neurol] 2024 Jun 21; Vol. 9 (3), pp. 212-220. Date of Electronic Publication: 2024 Jun 21. - Publication Year :
- 2024
-
Abstract
- Background: Aspirin is widely used for preventing ischaemic events. About 20%-40% of patients have aspirin resistance (ASR), which prevents them from benefiting from aspirin medication. This study aimed to develop and validate a model based on single-nucleotide polymorphism (SNP) to distinguish ASR patients.<br />Methods: We included patients with spontaneous intracerebral haemorrhage and continuing antiplatelet therapy from a multicentre, prospective cohort study as the derivation cohort. Thromboelastography (inhibition of arachidonic acid channel<50%) was used to identify ASR. Genotyping was performed to identify the ASR-related SNP. Based on the result of the logistic analysis, the aspirin resistance in the Chinese population score (ASR-CN score) was established, and its accuracy was evaluated using the area under the curve (AUC). Patients receiving dual antiplatelet therapy for unruptured intracranial aneurysm embolism were prospectively included in the validation cohort. After embolism, 30-day ischaemic events, including ischaemic stroke, new or more frequent transient ischaemic attack, stent thrombosis and cerebrovascular death, were recorded.<br />Results: The derivation cohort included 212 patients (155 male patients and the median age as 59). 87 (41.0%) individuals were identified with ASR. The multivariate logistic analysis demonstrated six SNPs of GP1BA, TBXA2R, PTGS2 and NOS3 as risk factors related to ASR. The ASR-CN score integrating these SNPs performed well to discriminate ASR patients from non-ASR patients (AUC as 0.77). Based on the validation cohort of 372 patients receiving antiplatelet therapy after embolism (including 130 ASR patients), the ASR-CN score continued to distinguish ASR patients with good accuracy (AUC as 0.80). Patients with high a ASR-CN score were more likely to suffer from 30-day ischaemic events after embolism (OR, 1.28; 95% CI, 1.10 to 1.50; p=0.002).<br />Conclusion: GP1BA, TBXA2R, PTGS2 and NOS3 were SNPs related to ASR. The ASR-CN score is an effective tool to discriminate ASR patients, which may guide antiplatelet therapy.<br />Clinical Trial Registration: Surgical Treatments of Antiplatelet Intracerebral Hemorrhage cohort (unique identifier: ChiCTR1900024406, http://www.chictr.org.cn/edit.aspx?pid=40640&htm=4).<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Humans
Male
Female
Middle Aged
Prospective Studies
Aged
Risk Factors
Risk Assessment
Reproducibility of Results
Pharmacogenomic Variants
China
Decision Support Techniques
Cerebral Hemorrhage genetics
Cerebral Hemorrhage chemically induced
Phenotype
Thrombelastography
Treatment Outcome
Clinical Decision-Making
Nitric Oxide Synthase Type III genetics
Cyclooxygenase 2 genetics
Dual Anti-Platelet Therapy adverse effects
Polymorphism, Single Nucleotide
Platelet Aggregation Inhibitors adverse effects
Platelet Aggregation Inhibitors therapeutic use
Drug Resistance genetics
Aspirin therapeutic use
Aspirin adverse effects
Predictive Value of Tests
Subjects
Details
- Language :
- English
- ISSN :
- 2059-8696
- Volume :
- 9
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Stroke and vascular neurology
- Publication Type :
- Academic Journal
- Accession number :
- 37586776
- Full Text :
- https://doi.org/10.1136/svn-2022-002228