Model based on single-nucleotide polymorphism to discriminate aspirin resistance patients

Highly specific screening of aspirin resistance-related single-nucleotide polymorphisms using ligase chain reaction strategy

Aspirin (ASP) is currently the drug of choice for antiplatelet therapy. However, approximately 5%-45 % of patients are resistant to ASP and do not achieve the expected result. At present, a few studies have investigated the correlation between ASP resistance (AR) and single-nucleotide polymorphism (SNP). Traditional detection methods are time-consuming and laborious, affecting the accuracy of personalized medicine. This study aimed to establish a new assay to identify four SNPs associated with AR. A large amount of double-stranded DNA was formed after multiple cycles of specific exponential amplification by ligase chain reaction, the specific melting peak of which was visible in the detection curve, with a detection limit of 10-11mol/L. The specificity experiments of different proportions of wild-type and mutant plasmid standards showed that the novel method could detect up to 1 % allele frequency and the specificity was good. Clinical blood samples of 57 patients were tested in this study. The results were consistent with those of sequencing and more accurate and reliable than those of the high-resolution melting method. The technique used in this study was simple, sensitive and specific compared with the traditional method. Statistical analysis revealed that AR was significantly correlated with the rs12041331 site of the PEAR1 gene and the rs1695 site of the GSTP1 gene, providing an important reference value for the study of AR.

Antithrombotic therapy following lower extremity endovascular revascularization: The results of a survey of vascular specialists

Objective

Antithrombotic therapy improves endovascular intervention outcomes for peripheral artery disease. However, there are limited data guiding the choice and duration of these adjuvant therapies. Thus, we explored current antithrombotic prescribing preferences among vascular interventionalists, hypothesizing that there are varied and inconsistent treatment practices among providers.

Methods

We developed and distributed a de-identified RedCap survey via Twitter and email to Vascular Quality Initiative members (February 2023). Multiple-choice questions queried antithrombotic agents and treatment durations for a clinical vignette (a claudicant on 81 mg aspirin and statin) with different arterial disease locations (iliac, femoropopliteal, or tibial vessels) and different revascularization strategies (angioplasty or stenting, with and without drug-coating). Antithrombotic options included monotherapies with antiplatelet agents or low-dose rivaroxaban; dual therapies with aspirin combined with a P2Y12 inhibitor (dual antiplatelet therapy, DAPT) or low-dose rivaroxaban (dual pathway inhibition or DPI); or triple therapy with aspirin, a P2Y12 inhibitor, and low-dose rivaroxaban. Options for therapy duration included 30, 90, 180, and 365 days, or indefinitely.

Results

There were 199 respondents (17% female, 68% White race, 63% academic, 88% vascular surgery). Across all treatment scenarios, respondents selected DAPT (n = 171/199; 86%) in at least one revascularization scenario, followed by aspirin monotherapy (n = 83/199; 42%) and DPI (n = 49/199; 25%). Therapy choice did differ by both anatomic location and revascularization strategy (P < .05). DAPT was most selected following femoropopliteal revascularization (n = 165/199, 83%) and bare metal stenting (n = 162/198, 82%). However, aspirin monotherapy was most selected following iliac level revascularization (n = 52/197; 26%) and following percutaneous transluminal angioplasty at any level (n = 51/182; 28%). DPI was most selected following tibial revascularization (n = 39/184; 21%) and following percutaneous transluminal angioplasty (n = 38/182; 21%). Among those who selected DAPT, the 90-day (n = 99/171; 58%) duration was preferred. Those who selected DPI favored indefinite treatment durations (n = 34/49; 69%). Indefinite DAPT and DPI therapy were more commonly selected for distal level revascularization (P < .05). Rivaroxaban utilization was limited secondary to cost (n = 108/178; 61%), lack of demonstrated effectiveness (n = 75/178; 42%), and concern for safety and bleeding (n = 27/178; 15%).

Conclusions

Following lower extremity endovascular treatment of peripheral artery disease, a 90-day duration of DAPT remains the most commonly selected antithrombotic regimen despite the emergence of DPI as an evidence-based antithrombotic therapy. The variability in provider preferred antithrombotic agent and treatment duration emphasizes the need for high-quality evidence for the medical optimization of revascularization outcomes.

Predicting laboratory aspirin resistance in Chinese stroke patients using machine learning models by GP1BA polymorphism

This study aims to use machine learning model to predict laboratory aspirin resistance (AR) in Chinese stroke patients by incorporating patient characteristics and single nucleotide polymorphisms of GP1BA and LTC4S. 2405 patients were analyzed to measure the Mutation frequency of GP1BA rs6065 and LTC4S rs730012. 112 patients with first-stroke arteriostenosis were prospectively enrolled to establish machine learning model. GP1BA rs6065 mutation frequency is 5.26% and LTC4S rs730012 is 14.78%. GP1BA rs6065 CT patients have more sensitivity to aspirin than CC genotype. Simple linear regression identified significant associations with age, smoking, HDL and GP1BA rs6065. Random forest (RF) and extreme gradient boosting (XGBoost) demonstrated predictive capabilities for AR. Findings suggest pre-identifying GP1BA rs6065 could optimize aspirin treatment, enabling personalized care and future research avenues.

Subacute in-stent thrombosis after carotid artery stenting in a patient with gene polymorphisms associated with aspirin and clopidogrel resistance: a case report

BACKGROUND

Carotid artery stenting (CAS) is a key treatment option for moderate to severe carotid artery stenosis. Carotid stent thrombosis (CST), a rare complication of CAS, has gained significant attention because of its catastrophic nature. More evidences are needed to guide the diagnosis and treatment of CST.

CASE PRESENTATION

This study reports a rare case of sub-acute CST following CAS in a 50-year-old male patient who had experienced repeated cerebrovascular events on the premise of taking antiplatelet drugs. He also suffered an occlusion of the left middle cerebral artery (MCA) in the M2 segment, likely caused by an embolus detached from the stent thrombus. The cause of CST in this patient was presumed to be dual antiplatelet resistance (AR), as indicated by genetic testing. After treated with guide catheter-directed thrombolysis, thrombus aspiration, and a second round of thrombolysis, his in-stent thrombus was basically cleared. His M2 occlusion was resolved by mechanical thrombectomy using the Solitaire FR/Stent with Intermediate Catheter Assisting technique. The patient recovered well after replacement of antiplatelet drugs, and no new thromboembolic event occurred during the 13-month follow-up period.

CONCLUSIONS

The occurrence rate of AR-related CST may be underestimated as the cause of majority CST cases remains unclear. Implementation of genetic test for aspirin and clopidogrel resistance may be helpful to find the possible cause of CST and to avoid future repeated cerebrovascular events by replacement of antiplatelet drugs.

Epoxidase inhibitor-aspirin resistance and the relationship with genetic polymorphisms: a review

Strokes are the leading cause of death in most regions of the world. Epoxidase inhibitors include the drug aspirin (acetylsalicylic acid). Aspirin is widely used as first-line treatment for the prevention of cardiovascular and cerebrovascular diseases in at-risk patients. However, patients using conventional doses of aspirin can still develop ischaemic cardiovascular and cerebrovascular diseases, a phenomenon known as aspirin resistance. The occurrence of aspirin resistance hinders the prevention and treatment of ischaemic cardiovascular and cerebrovascular diseases. There are many factors affecting aspirin resistance, such as sex, drug dose, metabolic disease, genetic polymorphisms, drug interactions and pharmacokinetics. Genetic polymorphism refers to the simultaneous and frequent presence of two or more discontinuous variants or genotypes or alleles in a population of organisms. Platelets contain a large number of highly polymorphic transmembrane glycoprotein receptors encoded by two or more isomeric alleles. Changes in gene polymorphisms in various pathways during platelet aggregation can lead to aspirin resistance. This narrative review describes the gene polymorphisms that have been demonstrated to be significantly associated with aspirin resistance. Research on the mechanisms of aspirin resistance and increased knowledge should provide accurate drug guidance in individuals that require first-line antiplatelet therapy.