Prevalence of persistent platelet reactivity despite use of aspirin: A systematic review

Hovens, Marcel M.C.; Snoep, Jaapjan D.; Eikenboom, Jeroen; Bom, Johanna G. van der; Mertens, Bart; Huisman, Menno V.

doi:10.1016/j.ahj.2006.10.040

Cited by 236 publications

(181 citation statements)

References 60 publications

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“…In this study, the overall prevalence of aspirin resistance was consistent with previous data (24%-28%) 8,9 and there was a significant correlation between aspirin resistance and coronary artery disease severity. The thrombolysis in myocardial infarction (TIMI) risk score 4 is a simple tool assessing risk of death and ischemic events in patients with UA/NSTEMI.…”

Section: Discussionsupporting

confidence: 92%

“…None of aspirin resistance assay tests are known to be superior to another in identifying aspirin resistance, particularly as no consensus on this has been reached. 8 Compared with platelet aggregometry which is considered the gold standard test of platelet function, the PFA-100 system offers important advantages because it is simple, cheap, and provides rapid results. 13 As we aimed to take blood samples at a time closest to the episode of chest pain, it was not possible to standardize the timing of the blood sampling after taking aspirin.…”

Section: Study Limitationsmentioning

confidence: 99%

“…The prevalence of aspirin resistance varies greatly, with a range of 0% to 57%. 6,7 Recently 2 meta-analysis 8,9 reported the mean prevalence of biochemical aspirin resistance between 24% to 28% and demonstrated that these patients were at greater risk of clinically significant cardiovascular morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Significance of Aspirin Resistance in Patients With Chest Pain

Aydınalp¹,

Atar²,

Gülmez³

et al. 2010

Clinical Cardiology

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BackgroundThere are conflicting data in the literature about the clinical significance of aspirin resistance.HypothesisWe aimed to prospectively evaluate the prevalence of biochemical aspirin resistance in patients on aspirin therapy who were admitted to the emergency clinic with chest pain. We also aimed to evaluate the relation between acute coronary syndromes (ACS) and aspirin resistance.MethodsA total of 338 patients were included in the study. Platelet reactivity was measured with the PFA‐100 system (Dade Behring Inc, Deerfield, IL). Aspirin resistance determined by the PFA‐100 was defined as a normal collagen and/or epinephrine closure time despite aspirin treatment (<165 s).ResultsPatients were divided into 4 groups: stable angina pectoris (SAP), unstable angina/non‐ST‐elevation myocardial infarction (UA/NSTEMI), ST‐elevation myocardial infarction (STEMI), and rule out ACS. Aspirin resistance was found in 81 (24%) patients in all groups. Patients with ACS had significantly more aspirin resistance than patients with rule out ACS or patients with SAP (P < .001). In the SAP group, 31 (19.6%) patients; in the UA/NSTEMI group, 19 (35.8%) patients; in the STEMI group, 14 (50%) patients; and in the rule out ACS group, 17 (17.2%) patients had aspirin resistance (P < .001). In the multivariate analysis, cardiac biomarker elevation on admission to emergency department and platelet count appeared as independent factors predictive of aspirin resistance.ConclusionsWe demonstrated that incidence of aspirin resistance was significantly higher in patients who were finally diagnosed as ACS, especially in aspirin‐taking patients admitted to the emergency clinic with STEMI. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 92%

Section: Study Limitationsmentioning

confidence: 99%

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The Clinical Significance of Aspirin Resistance in Patients With Chest Pain

Aydınalp¹,

Atar²,

Gülmez³

et al. 2010

Clinical Cardiology

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“…2 While once-daily low-dose aspirin appears to be the optimal dosing strategy for the majority of patients, as described above in the High-Risk Groups section, a significant percentage of patients have suboptimal antiplatelet response to standard aspirin dosing. In a large systemic review, Hovens et al 73 found that the prevalence of aspirin resistance was less among patients receiving greater than 300 mg of aspirin per day (19%) compared to those receiving less than 100 mg of aspirin per day (36%). It appears that the dose-dependent effect of aspirin in aspirin-resistant patients may be mediated by non-COX-1 pathways.…”

Section: Post-coronary Artery Bypass Graft Surgerymentioning

confidence: 99%

Aspirin Resistance: Current Status and Role of Tailored Therapy

Grinstein

Cannon

2012

Clinical Cardiology

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Aspirin is integral in the primary and secondary prevention of coronary artery disease and acute coronary syndrome. Given the high clinical importance of aspirin in the management of coronary artery disease, much attention has been directed towards the concept of “aspirin resistance.” Unfortunately, the term aspirin resistance is ill‐defined in the literature, leading to a large variance in the reported prevalence of this phenomenon. In this review, the current understanding of aspirin resistance is discussed. Commonly used functional and diagnostic tests of platelet function, including their strengths and weakness, are reviewed. We next discuss several proposed mechanisms of aspirin resistance and special high‐risk groups at risk for aspirin treatment failure. We then discuss optimal dosing and diagnostic strategies for those populations at risk for aspirin resistance with a focus on tailored aspirin therapy for high‐risk groups. Finally, future topics of interest in the field of aspirin resistance are considered. Clin. Cardiol. 2012 doi: 10.1002/clc.22031Jonathan Grinstein has no funding, financial relationships, or conflicts of interest to disclose. Christopher P. Cannon receives research grants/support from the following companies: Accumetrics, AstraZeneca, Essentialis, GlaxoSmithKline, Merck, Regeneron, Sanofi, and Takeda. He is also on the advisory board (but funds donated to charity) for Alnylam, Bristol‐Myers Squibb, and Pfizer. He is a Clinical Advisor, equity in Automedics Medical Systems.

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“…It is well-known that Increase fibrinogen levels are a consequence of inflammatory process 9 . Interestingly in this study fibrinogen level was significantly reduced after 2 weeks treatment with aspirin and this may be related to the anti-inflammatory effects of aspirin 10 . this study showed that aspirin plus Garcinia cambogia significantly reduce blood viscosity after 1 week of treatment and this statistically significant decrease in blood viscosity may pointed out a potential role of Garcinia cambogia as antioxidant in addition to aspirin in the reduction of blood viscosity.…”

Section: Parametersmentioning

confidence: 73%