アスピリン内服中の脳血管障害患者における脳血管障害の危険因子および頸動脈病変の血小板凝集能に及ぼす影響

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We studied effects of vascular risk factors and carotid atherosclerosis on platelet aggregation in aspirintreated stroke patients. A total of 146 outpatients (91 males and 55 females, mean age of 68 years) were analysed. Platelet aggregation induced by adenosine diphosphate (ADP), arachidonic acid (AA), platelet activating factor (PAF) was measured using turbidimetric aggregometry. Maximum intima-media thickness (Max-IMT) in bilateral carotid arteries was measured by duplex carotid ultrasonography. The carotid artery lesions were classified into the following three categories : no lesion (Max-IMT < 1.1 mm), mild plaque (Max-IMT 1.1-2.0 mm), and severe plaque (Max-IMT≧2.1 mm). Vascular risk factors included hypertension, hyperlipidemia, diabetes mellitus, and smoking. PAF-induced platelet aggregation was greater in hyperlipidemia (20±23% vs 11±13%, p=0.004) and smoking (19±22% vs 13±16%, p=0.037) patients. In addition, platelet aggregation induced by PAF tended to be greater in patients with all 4 risk factors (35±23%) than in those with 0-3 risk factors (14±18%, p=0.0595). However, platelet aggregation induced by ADP was smaller in patients with severe plaque than those with mild plague (27±14% vs 35±19%, p=0.024). To conclude, our findings may imply that PAF-induced platelet aggregation is resistant to aspirin treatment in patients with hyperlipidemia, smoking patients and in those with multiple risk factors, while ADP-induced platelet aggregation is over-suppressed in patients with severe carotid plague.

アスピリン内服中の脳血管障害患者における脳血管障害の危険因子および頸動脈病変の血小板凝集能に及ぼす影響

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