Resistencia a la aspirina: prevalencia, mecanismos de acción y asociación con eventos tromboembólicos. Revisión narrativa
Bibliographic record
Abstract
Revisar la prevalencia de resistencia a la aspirina en pacientes de alto riesgo cardiovascular y, de forma secundaria, investigar la epidemiología, los mecanismos de acción de este fenómeno y las consecuencias clínicas que se derivan de ello. Se realizó una búsqueda en PubMed, EMBASE y Reviews Database de artículos publicados en inglés y en español hasta noviembre de 2008 referidos a resistencia a la aspirina. Se hizo también un seguimiento de las referencias para recuperar aquéllas consideradas relevantes para los objetivos secundarios de esta revisión. La resistencia a la aspirina se describe entre un 0 y un 57%, lo que se traduce en una disminución de la eficacia protectora frente a eventos cerebrovasculares y cardiovasculares. Numerosos factores modificables, así como otros no modificables, influyen en la eficacia del efecto antiagregante. Las estrategias por seguir para contrarrestar esta antiagregación disminuida pueden dirigirse a un aumento de dosis de aspirina o a la terapia dual junto con otros agentes antiplaquetarios. La falta de respuesta a la aspirina disminuye su eficacia protectora. Sin embargo, la falta de una definición de resistencia a la aspirina universalmente consensuada y la inexistencia de un método diagnóstico de referencia que identifique con fiabilidad a pacientes resistentes, así como los diferentes mecanismos de acción implicados en la agregación plaquetaria, cuestionan la relevancia clínica de este fenómeno. Son necesarios más estudios clínicos adecuadamente diseñados para detectar pacientes con verdadera resistencia a la aspirina y así conseguir prevenir de manera más eficaz la morbimortalidad cardiovascular. The purpose of this study is to review the prevalence of aspirin resistance in patients with a high risk of cardiovascular events, and secondly, to investigate its epidemiology and mechanism of action, and the clinical consequences it can provoke. A search was run on PubMed, EMBASE and Reviews Database for English or Spanish articles on aspirin resistance published up to November 2008. Additional studies were obtained by searching the reference lists in the selected articles for articles relevant to our secondary objectives. Aspirin resistance is described as affecting 0 to 57% of the population, and is related to a decreased protective effect against strokes and cardiovascular events. Many modifiable and unmodifiable factors can affect the efficacy of antiplatelet drugs. Possible strategies for overcoming this decreased antiaggregant effect include increasing the aspirin dosage or dual therapy with another antiplatelet agent. Lack of response to aspirin decreases its protective effects. However, lack of a standard definition for aspirin resistance, the absence of diagnostic reference methods to identify resistant patients, and the different mechanisms of action involved in platelet aggregation call the clinical importance of this fact into question. Additional well-designed studies are needed to detect patients with real resistance in order to have more effective prevention of cardiovascular morbidity and mortality.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".