Main Article Content


Endothelial dysfunction and vascular injuries are the early processes in thrombogenesis leading to thrombotic stroke. These processes trigger platelet activation characterized by synthesis of Thromboxane A2, potent agonist in platelet aggregation. Acetosal (ASA) 100 mg usually given to thrombotic stroke patients exerts its pharmacological effect by inhibition of TxA2 synthesis, thus could prevent thrombus formation. Diabetes mellitus (DM) as risk factor of thrombotic stroke exhibits an increase in TxA2 synthesis. It is not known whether ASA 100 mg could inhibit TxA2 adequately in diabetic patients. This study aimed to analyze the differences of serum TxA2 level, which was measured by serum TxB2 level as stabile metabolite of TxA2, after taking ASA 100 mg in diabetic and non-diabetic thrombotic stroke patients. This prospective observational study was held in Neurology Department of Dr. Soetomo Hospital, Surabaya. Total 27 patients, consisted of 15 patients with DM and 12 patients with non-DM were enrolled. Serum TxB2 was measured before and after 5-7 days 100 mg ASA 100 administration. Mean value of serum TxB2 level before and after taking ASA was 16.43 ± 16.08 ng/mL and 2.93 ± 1.83 ng/mL in diabetic and 27.36 ± 21.04 ng/mL and 5.36 ± 4.06 ng/mL in non-diabetic group. Mean reduction of serum TxB2 level in diabetic and non-diabetic group was 13.49 ± 15.9 ng/mL and 22.00 ± 21.65 ng/mL. There were significant differences in serum TxB2 level after taking ASA 100 mg in diabetic and non-diabetic group but the mean reduction of serum TxB2 level were not significantly different.


Thrombotic stroke acetosal thromboxane A2 thromboxane B2 diabetes mellitus

Article Details

How to Cite
Hadiyanti, N., Hasmono, D., & Islam, M. S. (2018). Analysis of Differences of Serum Thromboxane B2 Level after Taking Acetosal in Acute Thrombotic Stroke with Diabetes Mellitus and Non-Diabetes Mellitus. Folia Medica Indonesiana, 54(1), 53–58.


  1. Badan Penelitian dan Pengembangan Kesehatan. (2013). Riset Kesehatan Dasar. Jakarta, Kementrian Kesehatan Republik Indonesia, p v, ix, 91-94
  2. Biller J, Love BB, Scheck, MJ (2012). Vascular disease of the nervous system: ischemic cerebrovas-cular disease. In: Daroff RB, Fenichel GM, Jankovic J and Mazziotta J. (Eds). Bradley’s Neurology in Clinical Practice 6th ed. Philadelphia, Elsevier, p 1003-1053
  3. Cattaneo M (2007). Laboratory detection of ‘aspirin resistance’: what test should we use (if any)?. Euro-pean Heart Journal 28, 1673-1675
  4. DeLoughery TG (2015). Antiplatelet agents. in: DeLoughery TG. (Ed). Hemostasis and Thrombosis 3rd Ed. Switzerland, Springer, p 107-110, 133-137
  5. DiChiara J, Bliden KP, Tantry US, Hamed MS, Antonino MJ, Suarez TA, Bailon O, Singla A, Gurbel PA (2007). The effect of aspirin dosing on platelet function in diabetic and nondiabetic patients – An Analysis from the Aspirin-induced Platelet Effect (ASPECT) study. Diabetes, 3014-3019
  6. Ferreiro JL and Angiolillo DJ. (2011). Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation 123, 798-813
  7. Ferroni P, Basili S, Falco A and Davi G. (2004). Platelet activation in type 2 diabetes mellitus. Journal of Thrombosis and Haemostasis, 1282-1291
  8. Furie B. and Furie BC, (2008). Mechanism of thrombus formation. The New England Journal of Medicine 359, 938-949
  9. Fuster V, Chesebro JH, Frye RL and Elveback LR. (1981). Platelet survival and the development in the young adult: effect of cigarette smoking, strong family history and medical therapy. Circulation 63, 546-550
  10. Gkaliagkousi E, Passacquale G, Dourna S, Zamboulis C and Ferro A. (2010). Platelet activation in essential hypertension: implication for antiplatelet treatment. American Journal of Hypertension, 229-236
  11. Golan DE, Tashjian AH, Amstrong EJ, Armstrong AP (2012). Principle of Pharmacology the Pathophysio-logy Basis of Drug Therapy 3rd Ed. Philadelphia, Lippincott Williams & Wilkins: Philadelphia, p 372-394
  12. Hankey GJ, Eikelboom JW (2006). Aspirin resistance. Lancet 367, 606-617
  13. Hess K, Grant PJ (2011). Inflammation and thrombosis in diabetes. Thrombosis and Haemostasis 105, s43-s54
  14. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, et al (2014). Guideline for the prevent-ion of stroke in patients with stroke and transient ischemic attack. Stroke vol. 45, 1-77
  15. Kodiatte TA, Manikyam UK, Rao SB, Jagadish TM, Reddy M, Lingaiah HKM and Lakshmaiah V. (2012). Mean platelet volume in type 2 diabetes mellitus. Journal of Laboratory Physicians 4, 5-9
  16. Langhorne P. Stroke Disease. (2014). In: Walker BR, Colledge NR, Ralston SH, Penman ID (Eds). Davidson’s Principle and Practice of Medicine. 22nd Ed. Edinburgh, Elsevier, p 1237-1242
  17. Lip GYH (2003). Hypertension, platelets and the endothelium: the thrombotic paradox of hypertension (or Birmingham Paradox) revisited. Hypertension, 199-200
  18. Lopez LR, Guyer KE, Torre IG, Pitts, KR, Matsuura E, Ames RJ (2014). Platelet thromboxane (11-dehydro-Thromboxane B2) and Aspirin response in patients with diabetes and coronary artery disease. World Journal of Diabetes 5, 115-127
  19. Natarajan A, Zaman AG, Marshall SM (2008). Platelet hyperactivity in type 2 diabetes: role of antiplatelet agents. Diabetes and Vascular Disease Research 5, 138-144
  20. Powers AC (2012). Diabetes Mellitus. In: Longo DL, Fauci AC, Kasper DL, Hauser SL, Jameson JL and Loscalzo J. (Eds). Harrison’s Principle of Internal Medicine 18th Ed. New York, McGraw Hill, p 2968-2987
  21. Pulcinelli FM, Biasucci LM, Riondino S, Giubilato S, Leo A, Renzo LD, Trifiro E, Mattielo T, Pitocco D, Liuzzo G, Ghirlanda G and Crea F. (2009). COX-1 sensitivity and Thromboxane A2 production in type 1 and type 2 diabetic patients under chronic aspirin treatment. European Heart Journal, 1279-1286
  22. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, and Vinters HV. (2013). An update definition of stroke for the 21st century. Stroke, 2064-2089
  23. Smith WS, English JD and Johnston SC. (2013). Cerebrovascular Disease. In: Hauser SL and Joseph-son SA (Eds). Harrison’s Neurology in Clinical Medicine 3rd Ed. New York, McGraw Hill Education, p 256-273
  24. Takajo Y, Ikeda H, Haramaki N, Murohara T. and Imaizumi T (2001). Augmented oxidative stress of platelet in chronic smokers – Mechanism of impaired platelet-derived nitric oxide bioactivity and augmented platelet aggregability. Journal of the American College Cardiology 38, 1320-1327
  25. Thorvaldsen P, Kuulasma K, Rajakangas AM, Raste-nyte D, Sarti C and Wilhelmsen L. (1997). Stroke trends in the WHO MONICA Project. Stroke, 500-506
  26. Wang N, Tall AR. (2016). Cholesterol in platelet biogenesis and activation. Blood 127, 1949-1953
  27. Widmaier EP, Raff H, Strang KT (2014). Vander’s Human Physology: The Mechanism of Body Function 13th Ed. New York, McGraw Hill, p 432-438
  28. Zehnder JL, Tantry US and Gurbel PA (2016). Non-response and resistance to aspirin. Wolters Kluwer UpToDate, 1-9

Most read articles by the same author(s)