Correlation of Clinical and Laboratory Aspirin Resistance: A Pilot Study


Affiliations

  • Manipal University, Kasturba Medical College, Manipal, Karnataka, 576104, India

Abstract

Aspirin resistance may be biochemical or clinical. Data related to the presence of aspirin resistance in the Indian population is scarce. We conducted a cross sectional study to address the issue of clinical aspirin non responsiveness and to assess the association between inhibition of platelet aggregation, clinical risk factors and occurrence of vascular events. We studied platelet aggregation by optical aggregometry in 20 patients on aspirin. No patient was found to be aspirin-resistant on the basis of pr eviously defined criteria. This led us to relook at the current cut offs for resistance, and an analysis of 60 normal patients showed lower cut off values suggesting ethnic variabil ity. The data was reanalyzed using these cutoffs. An association between poor clinical aspirin response, older age, male sex, smoking and dyslipidemia was found, suggesting a trend, though not significant. 25% of patients had vascular events on aspirin sugges ting clinical aspirin resistance. A lower cut off value for aspirin resistance in normal Indians may be needed to detect true prevalence of this entity. In patients with mul tiple atherothrombotic risk factors lab detection of resistance may be useful in identifyi ng patients with high risk for recurrent vascular events. This may help to modify antiplatelet therapy to prevent vascular events.

Keywords

Aspirin, Platelet Function, Clinical Correlation, Risk Factor.

Subject Discipline

Pharmacy and Pharmacology

Full Text:

References

Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.

Collaborative review of randomized trials of antiplatelet therapy-1: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialist collaboration. BMJ 1994; 308: 81–106.

Eikelboom JW, Hankey GJ. Aspirin resistance: a new independent predictor of vascular events? J Am Coll Cardiol 2003; 41: 966–968

Grotemeyer KH. Effects of acetylsalicylic acid in stroke patients. Evidence of nonresponders in a subpopulation of treated patients. Thromb Res 1991; 63: 587-93.

Helgason CM, Tortorice KL, Winckler SR, Penney DW, Schuler JJ, Mc Clelland TJ, et al. Aspirin response and failure in cerebral infarction. Stroke 1993; 24: 345-50.

Grotemeyer KH, Scharafinski HW, Husstedt IW. Two-year followup of aspirin responder and aspirin non-responder. A pilot-study including 180 post-stroke patients. Thromb Res 1993; 71: 397-403.

Hegalson CM, Bolin KM, Hoff JA, Winkler SR, Mangat A, Tortorice KL, et al. Development of aspirin resistance in persons with previous ischemic stroke. Stroke 1994; 25: 2331-6.

Gum PA, Kottke-Marchand K, Poggio ED, Gurm H, Welsh PA, Brooks L, et al. Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 2001; 88: 230-5.

Fateh –Moghadam U, Plöckinger N.Cabeza, P. Htun, T. Reuter, S. Ersel, M. Gawaz, R. Dietz, W. Bocksch. Prevalence of aspirin resistance in patients with type 2 diabetes. Acta Diabetol 2005 42:99–103

Sacco M, Pellegrini F, Roncaglioni MC, Avanzini F, Tognoni G, Nicolucci A; PPP Collaborative Group (2003) Primary prevention of cardiovascular events with low-dose aspirin and vitamin E in type 2 diabetic patients, results of the primary prevention project (PPP) trial. Diabetes Care 26:3264–3272.

de Gaetano G, Cerletti C. Aspirin resistance: a revival of platelet aggregation tests? J Thromb Haemost. 2003; 1:2048-2050.

Sadiq PA, Puri A, Dixit M, Ghatak A, Dwivedi SK, Narain VS, Saran RK, Puri VK. Profile and prevalence of aspirin resistance in Indian patients with coronary artery disease. Indian Heart J. 2005 Nov-Dec; 57(6):658-61.

Grundmann K, Jaschonek K, Kleine B, Dichgans J, Topka H. Aspirin nonresponder status in patients with recurrent cerebral ischemic attacks. J Neurol 2003; 250:63–66.

Mueller MR, Salat A, Stangl P, et al. Variable platelet response to lowdose ASA and the risk of limb deterioration in patients submitted to peripheral arterial angioplasty. Thromb Haemost 1997; 78:1003–1007.

Hung J, Lam JY, Lacoste L, Letchacovski G. Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. Circulation 1995; 92: 2432-6.

Friend M, Vucenik I, Miller M. Platelet responsiveness to aspirin in patients with hyperlipidaemia. BMJ 2003; 326: 82-3.

Meade TW, Brennan PJ. Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial. BMJ. 2000; 321(7252):13-7.

Colwell JA, Nesto RW The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care 2003 26: 2181–2188


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