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Platelet response to low-dose enteric-coated aspirin in patients with stable cardiovascular disease.

Abstract：

OBJECTIVES:We investigated whether use of low-dose enteric-coated (EC) aspirin for secondary prevention of cardiovascular events has sufficient bioavailability to achieve complete platelet cyclooxygenase (COX) inhibition in all individuals. BACKGROUND:Aspirin reduces cardiovascular morbidity and mortality in patients with pre-existing vascular disease; however, there is variability in the way individuals respond. Persistent normal platelet function despite therapy, referred to as "aspirin resistance," is associated with an increased risk of major cardiovascular events. METHODS:We studied 131 stable cardiovascular patients between March and September 2002 who were taking 75 mg EC aspirin. Serum thromboxane (TX) B2 levels were assayed as a measure of COX activity. Mean arachidonic acid (AA)-induced platelet aggregation > or =20% was deemed evidence of persistent platelet activity and an incomplete aspirin response. RESULTS:Patients of median age 63 years (61% men) were enrolled. Forty-four percent of patients had elevated serum TX B2 levels (>2.2 ng/ml). Arachidonic acid-induced platelet aggregation occurred more frequently in these patients (21% vs. 3%; p = 0.004). In all cases addition of exogenous aspirin during the assay abolished platelet aggregation. Patient weight and age were significant independent predictors of an incomplete response to EC aspirin (p = 0.025 and p < 0.001, respectively). These patients were also more likely to have a history of myocardial infarction (MI) (p = 0.038). CONCLUSIONS:Many patients who are prescribed low-dose EC aspirin for secondary prevention of cardiovascular events have persistent uninhibited platelet COX activity. Younger and heavier patients and those with a previous MI are most likely to have an inadequate response to treatment.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Maree AO,Curtin RJ,Dooley M,Conroy RM,Crean P,Cox D,Fitzgerald DJ

doi

10.1016/j.jacc.2005.06.058

subject

Has Abstract

pub_date

2005-10-04 00:00:00

pages

1258-63

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)01652-9

journal_volume

pub_type

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Platelet response to low-dose enteric-coated aspirin in patients with stable cardiovascular disease.