The effect of acetylsalicylic acid dosed at bedtime on the anti-aggregation effect in patients with coronary heart disease and arterial hypertension: A randomized, controlled trial

Abstract

Background: Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention of coronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggested that the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctions and strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening) dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH). Methods: The study involved 175 patients with CAD and AH. Patients were randomly assigned to one of two study groups, taking ASA in the morning or in the evening. The patients had two visits, one baseline and another after 3 months from changing the time of ASA dosage. The platelet aggregation was determined using the VerifyNow analyzer. Results: In the ASA evening group, a significant reduction in platelet aggregation was obtained. In the ASA morning group, a significant difference in response to ASA was observed, depending on sex. In men, the reactivity of platelets decreased, but in women it increased. Conclusions: In the group of patients with CAD and AH, bedtime ASA dosing is associated with a significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefit gained by changing the drug administration from the morning to the evening is greater in women.

Evening aspirin intake results in higher levels of platelet inhibition and a reduction in reticulated platelets - a window of opportunity for patients with cardiovascular disease?

“…The first finding, of a superior level of inhibition after ODevening intake of aspirin in comparison with OD-morning intake, is consistent with the results of several other studies, both in healthy subjects and patients with stable cardiovascular disease [11][12][13][14]25]. As most CVE's occur during -early morning hours [26,27], optimal platelet inhibition during these hours seems prudent.…”

Circadian Rhythm of Cardiovascular Disease: The Potential of Chronotherapy With Aspirin

“…One parallel RCT and three randomized cross-over trials reported more platelet inhibition, measured by the VerifyNow, after evening intake of low-dose aspirin compared with the standard once daily morning dosing (2, 59, 66, 67).…”

The Effect of Mushroom Extracts on Human Platelet and Blood Coagulation: In vitro Screening of Eight Edible Species

“…According to the 2016 European Guidelines on cardiovascular prevention in clinical practice, ASA prophylaxis is not recommended for subjects who do not suffer from CVD because of an increased risk of major bleeding [9]. It has also been demonstrated that time of administration strongly affects the outcome of ASA on platelet function [10]. This creates a necessity to seek alternative and safe dietary antiplatelet agents.…”