Aspirin resistance: An update

Lancaster, Gilead; Srinivasan, Janardhan; Jain, Hitender

doi:10.1007/s11883-009-0017-7

Cited by 6 publications

(4 citation statements)

References 46 publications

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“…The rate of aspirin resistance is widely variable, ranging from 5 to 60% of the population affected by cardiovascular and cerebrovascular diseases in different studies [58–60]. It is difficult to know the exact prevalence of aspirin resistance from these studies because of variabilities in definitions for aspirin resistance, variabilities in testing and measurement between studies, small sample size of the studies, and different populations used in the studies.…”

Section: Aspirin Resistancementioning

confidence: 99%

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Dai

2012

Thrombosis

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Cardiovascular disease (CVD), principally heart disease and stroke, is the leading cause of death for both males and females in developed countries. Aspirin is the most widely used and tested antiplatelet drug in CVD, and it is proven to be the cornerstone of antiplatelet therapy in treatment and prevention of CVD in clinical trials in various populations. In acute coronary syndrome, thrombotic stroke, and Kawasaki's disease, acute use of aspirin can decrease mortality and recurrence of cardiovascular events. As secondary prevention, aspirin is believed to be effective in acute coronary syndrome, stable angina, revascularization, stroke, TIA, and atrial fibrillation. Aspirin may also be used for patients with a high risk of future CVD for primary prevention, but the balance between benefits and the possibility of side effects must be considered.

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Section: Aspirin Resistancementioning

confidence: 99%

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Dai

2012

Thrombosis

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“…In addition, platelet activity and platelet responsiveness to aspirin are assessed using a variety of laboratory techniques. Evaluation of thromboxane generation, platelet aggregation, platelet activation, bleeding time, and many more are all examples of such techniques [22].…”

Section: Negative Consequences Of Aspirinmentioning

confidence: 99%

Impact Analysis of Aspirin over the Cardiac Activity

Rani¹,

Singh²,

Laxmi³

2022

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Cardiovascular disease (CVD) is the leading cause of death in most developed countries, including the United States, with a significant economic impact. Lifestyle changes and the administration of antiplatelet medication, like aspirin, may significantly contribute to the secondary prevention of CVD in adults. For years, aspirin has been utilized for both secondary and primary cardiovascular disease prevention. Aspirin has been extensively used because of the belief that it may have a positive impact on primary prevention, despite the debate surrounding its usage. This study briefly examines usage patterns and discusses the potential variables and factors that can decrease the ability of aspirin to prevent cardiovascular disease. The present study also explore the key studies of aspirin use in the context of recent recommendations. The risk of bleeding has been observed to significantly rise, although large randomized clinical studies have demonstrated a reduction or absence of CVD events. Prevention strategies for cardiovascular disease with low-dose aspirin are no longer advised for persons at intermediate risk. To determine whether taking aspirin is worth the potential dangers, the benefits must be evaluated.

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“…4,5 In these cases, alternate therapeutic approaches could include either replacing or adding another antiplatelet such as clopidogrel to aspirin. 1,6,7 Clinicians will often switch to another antiplatelet such as clopidogrel after a new non-cardioembolic cerebral ischemic event under acetylsalicylic acid (ASA) therapy. 7 However, this clinical practice has not been shown to be effective and lacks any direct supportive evidence.…”

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confidence: 99%

ASA failure

et al. 2014

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Objective: To assess whether adding clopidogrel to acetylsalicylic acid (ASA) has a long-term protective vascular effect in patients with lacunar stroke while taking ASA.Methods: Post hoc analysis of 838 patients with ASA failure and recent lacunar stroke from the Secondary Prevention of Small Subcortical Strokes Trial (SPS3) cohort randomly allocated to aspirin (325 mg/day) and clopidogrel (75 mg/day) or placebo. Primary efficacy outcome was stroke recurrence (ischemic and intracranial hemorrhage) and main safety outcome was major extracranial hemorrhage. Patients were followed for a mean period of 3.5 years.Results: The ASA failure group had a significantly higher risk of vascular events including ischemic stroke when compared with the non-ASA failure group (n 5 2,151) in SPS3 (p 5 0.03). Mean age was 65.6 years and 65% were men. The risk of recurrent stroke was not reduced in the dual antiplatelet group, 3.1% per year, compared to the aspirin-only group, 3.3% per year (hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.61-1.37). There was also no difference between groups for ischemic stroke (HR 0.90; 95% CI 0.59-1.38). The risk of gastrointestinal bleeding was higher in the dual antiplatelet group (HR 2.7; 95% CI 1.1-6.9); however, the risk of intracranial hemorrhage was not different. Conclusions:In patients with a recent lacunar stroke while taking ASA, the addition of clopidogrel did not result in reduction of vascular events vs continuing ASA only. Classification of evidence:This study provides Class I evidence that for patients with recent lacunar stroke while taking ASA, adding clopidogrel as compared to continuing ASA alone does not reduce the risk of recurrent stroke. Some patients with cardiovascular conditions have events while treated with aspirin. This observation, termed aspirin treatment failure, can be due to multiple reasons, including poor adherence and presence of multiple vascular risk factors enhancing platelet activation.1-3 A laboratory resistance to aspirin has also been described in approximately 15%-20% of cerebrovascular patients. 4,5 In these cases, alternate therapeutic approaches could include either replacing or adding another antiplatelet such as clopidogrel to aspirin. 1,6,7 Clinicians will often switch to another antiplatelet such as clopidogrel after a new non-cardioembolic cerebral ischemic event under acetylsalicylic acid (ASA) therapy.7 However, this clinical practice has not been shown to be effective and lacks any direct supportive evidence. In addition, the combination of ASA and clopidogrel is not recommended for long-term secondary stroke prevention in current guidelines, based on lack of proven efficacy and increased hemorrhagic risk. 8,9 Although recent evidence appears to suggest a potential benefit for the combination of ASA and clopidogrel in the acute setting, additional confirmatory evidence is needed.10 Previous studies 11,12 that have assessed the combination of ASA and clopidogrel have not taken into consideration aspirin failure as a potential ...

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Aspirin resistance: An update

Cited by 6 publications

References 46 publications

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Impact Analysis of Aspirin over the Cardiac Activity

ASA failure

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