Coagulation status and determinants of possible aspirin resistance in patients with essential thrombocythemia

Erpeng Yang; Yan Lv; Ziqing Wang; Dehao Wang; Yumeng Li; Yan Sun; Yanyu Zhang; Jicong Niu; Zhuo Chen; Weiyi Liu; Xiaomei Hu

doi:10.3389/fmed.2022.1092281

Coagulation status and determinants of possible aspirin resistance in patients with essential thrombocythemia

Front Med (Lausanne). 2022 Dec 20:9:1092281. doi: 10.3389/fmed.2022.1092281. eCollection 2022.

Authors

Erpeng Yang¹, Yan Lv¹, Ziqing Wang², Dehao Wang², Yumeng Li¹, Yan Sun¹, Yanyu Zhang¹, Jicong Niu¹, Zhuo Chen¹, Weiyi Liu¹, Xiaomei Hu¹

Affiliations

¹ Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
² Xiyuan Clinical Medical College, Beijing University of Traditional Medicine, Beijing, China.

Abstract

Objectives: The currently recommended aspirin regimen appears inadequate for thromboprophylaxis in essential thrombocythemia (ET). This study aimed not only to evaluate the curative effect of aspirin but also to explore the coagulation status and determinants of aspirin resistance (AR) of ET patients.

Methods: A total of 80 ET patients who underwent coagulation tests, thromboelastography (TEG), and next-generation sequencing (NGS) were involved in the study. Patients were divided into the aspirin sensitivity (AS) group and AR group according to the arachidonic acid inhibition rate. Their clinical features and coagulation function were analyzed.

Results: The incidence of AR was 53.75% (43/80) in 80 ET patients. Fbg was significantly higher in coagulation tests in AR patients compared with AS patients (P < 0.05), while the differences in other variables (D-D, PT, PTA, INR, APTT, TT, FDP, and AT-III) were not statistically significant (P > 0.05). Compared with AS patients, the K values, α angles, MA values, and CI values of TEG in AR patients were statistically smaller (P < 0.05), but there was no significant difference in R value between them (P > 0.05). Univariate and multivariate logistic regression analysis showed that age, irregular use of aspirin, smoking, dyslipidemia, and hypertension increased the risk of AR (P < 0.05). In the routine NGS, the driver gene and non-driver gene had no effect on AR in ET patients.

Conclusion: Compared with AS patients, AR patients have enhanced platelet aggregation function, are in a relatively hypercoagulable state, and haveelevated fibrinogen function/levels, all of which cause a worse coagulation status. ET patients with increasing age, irregular use of aspirin, smoking, dyslipidemia, and hypertension are possibly at higher risk of AR. The routine NGS may not be helpful for the prediction of AR, therefore we recommend adding relevant drug-resistance genes to NGS.

Keywords: aspirin resistance; clinical features; coagulation status; essential thrombocythemia; next-generation sequencing.