The problem of body weight in cardioprophylaxis: optimization of antiplatelet therapy in overweight patients | Ukrainian Medical Journal

Modern cardioprophylaxis requires a personalized approach, since the effectiveness of standard low doses of acetylsalicylic acid (ASA) progressively decreases in patients with a body weight of more than 70 kg, obesity and type 2 diabetes. The aim of the review is to analyze the biopharmaceutical and pathophysiological mechanisms of this phenomenon. The decrease in antithrombotic protection is due to an increase in the volume of distribution of the drug, accelerated clearance, as well as intensification of thrombocytopoiesis against the background of chronic metabolic inflammation. The constant influx of reticulated platelets with intact cyclooxygenase (COX)-1 into the bloodstream forms the phenomenon of platelet escape between drug doses. The situation is significantly worsened when using enteric-coated forms of ASA due to their slow and unpredictable absorption in the intestine. A scientifically and clinically justified solution to overcome this kinetic deficiency is to switch to uncoated rapid-release ASA with antacid buffer of magnesium hydroxide (Cardiomagnyl®). Absorption of the drug directly in the stomach ensures that peak concentrations are achieved in 20–40 min (versus 4–6 h in enteric forms), which allows for reliable blocking of more than 98% of COX-1 by the time the substance is diluted in the tissues and guarantees stable antiplatelet protection in patients with high body weight without the additional risk of gastrointestinal complications.

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