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Nederlands Tijdschrift voor Diabetologie

, Volume 10, Issue 2, pp 47–56 | Cite as

De invloed van aspirinedosis en glycemische controle op plaatjesremming bij patiënten met diabetes mellitus type 2

Aspirine bij diabetes mellitus type 2
  • B.A. Lemkes
  • L. Bähler
  • P.W. Kamphuisen
  • A.K. Stroobants
  • E.J. van den Dool
  • J.B. Hoekstra
  • R. Nieuwland
  • V.E. Gerdes
  • F. Holleman
Cardiovasculair
  • 5 Downloads

Samenvatting

Achtergrond

Laaggedoseerd aspirine lijkt geen voordeel te bieden bij de primaire preventie van cardiovasculaire ziekte bij diabetes mellitus type 2 (DM2). Het anti-plaatjeseffect kan afnemen door hyperglycemie of inadequate dosering van aspirine.

Doelstellingen

Het bestuderen van de effecten van zowel glycemische controle als toenemende aspirine op de plaatjesreactie op aspirine bij DM2-patiënten en gematchte controlepersonen.

Patiënten/methoden

Plaatjeseffecten van toenemende doses aspirine (dagelijks 30-100-300 mg) werden prospectief beoordeeld in 94 patiënten met DM2 en 25 gematchte controlepersonen door met behulp van VerifyNow en lichttransmissie-aggregometrie (LTA) de tromboxaangehalten in urine (11-dhTxB2) en plaatjesaggregatie te meten. Patiënten met DM2 werden gestratificeerd op glycemische controle (HbA1c =53 mmol/mol, 53-69 mmol/mol, =69 mmol/mol).

Resultaten

Bij aanvang was de mediane 11-dhTxB2-excretie hoger bij de slecht gecontroleerde patiënten (77 ng/mmol) en de matig gecontroleerde patiënten (84 ng/mmol) in vergelijking met de goed gecontroleerde patiënten (64 ng/mmol) en controlepersonen (53 ng/mmol), p<0,01. 30 mg aspirine verlaagde de 11-dhTxB2-excretie tot 31, 29 en 24 ng/mmol in respectievelijk de slecht, matig en goed gecontroleerde patiënten en tot 19 ng/mmol in controlepersonen, p<0,001. Bij VerifyNow en LTA werd ook incomplete onderdrukking gezien bij DM2-patiënten die 30 mg aspirine kregen, maar 100 mg leidde in alle groepen tot vergelijkbare plaatjesonderdrukking, terwijl 300 mg geen extra effect opleverde.

Conclusies

DM2-patiënten met inadequate glycemische controle (HbA1c>53mmol/mol) hebben bij aanvang een hogere plaatjesactiviteit en incomplete onderdrukking van plaatjesactiviteit met 30 mg aspirine.100 mg aspirine leidt echter tot optimale remming, ongeacht glycemische controle, en 300 mg leidt niet tot verdere verbetering van de plaatjesonderdrukking.

Summary

Background

Low-dose aspirin seems to offer no benefit in primary prevention of cardiovascular disease in type 2 diabetes mellitus (DM2). The anti-platelet effect may be diminished by hyperglycemia or inadequate dosing of aspirin.

Objectives

To study the effects of both glycemic control and increasing aspirin dose on platelet response to aspirin in DM2 patients and matched controls.

Patients/methods

Platelet effects of increasing doses of aspirin (30- 100-300 mg daily) were prospectively assessed in 94 DM2 patients and 25 matched controls by measuring thromboxane levels in urine (11-dhTxB2) and platelet aggregation using VerifyNow and light transmission aggregometry (LTA). DM2 patients were stratified for glycemic control (HbA1c ≤53 mmol/mol, 53-69 mmol/mol, ≥69 mmol/mol).

Results

At baseline, median 11-dhTxB2 excretion was higher in the poorly controlled patients (77 ng/mmol), and the moderately controlled (84 ng/mmol) compared to the well controlled patients (64ng/mmol) and controls (53 ng/mmol), p<0.01. 30 mg of aspirin reduced 11-dhTxB2 excretion to 31, 29 and 24 ng/mmol in the poorly, moderately and well controlled patients respectively, and to 19 ng/mmol in controls, p<0.001. VerifyNow and LTA were also incompletely suppressed in DM2 patients at 30 mg of aspirin, but 100 mg resulted in comparable platelet suppression in all groups, with no additional effect of 300 mg.

Conclusions

DM2 patients with inadequate glycemic control (HbA1c>53mmol/mol) have higher baseline platelet activity and incomplete suppression of platelet activity with 30 mg of aspirin. However, 100 mg of aspirin leads to optimal inhibition irrespective of glycemic control, and 300 mg does not further improve platelet suppression.

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Copyright information

© Bohn Stafleu van Loghum 2012

Authors and Affiliations

  • B.A. Lemkes
    • 1
  • L. Bähler
    • 1
  • P.W. Kamphuisen
    • 2
  • A.K. Stroobants
    • 3
  • E.J. van den Dool
    • 3
  • J.B. Hoekstra
    • 1
  • R. Nieuwland
    • 3
  • V.E. Gerdes
    • 2
  • F. Holleman
    • 1
  1. 1.Afdeling Interne GeneeskundeAcademisch Medisch CentrumAmsterdamThe Netherlands
  2. 2.Afdeling Vasculaire GeneeskundeAcademisch Medisch CentrumAmsterdamThe Netherlands
  3. 3.Afdeling Klinische ChemieAcademisch Medisch CentrumAmsterdamThe Netherlands

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