Biochemical aspirin resistance in acute stroke patients and its association with clinical factors: a prospective pilot study

Abstract

Introduction: Aspirin is still widely used in treatment and prevention of cardiovascular diseases. To predict which patients cannot benefit from aspirin due to aspirin resistance remains a great clinical challenge. Material and methods: Fifty one acute stroke/transient ischemic attack (TIA) patients (ASG) with a history of regular aspirin intake for the previous 7 days or more were included to the study within 24 hours of symptoms onset. Twenty nine patients admitted to our department for other reasons were the controls (CG). Each patient underwent routine blood tests (white blood cells, platelets, total cholesterol, C-reactive protein) and additional blood test: glycated haemoglobin (HbA1c), insulin, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Biochemical aspirin resistance was measured using the VerifyNow Aspirin platelet function analyzer.Results: There were 9 aspirin resistance patients in ASG (17.5%) and 3 in CG (10.3%) (p = 0.38). There were no differences in either age or gender between those groups. Twelve aspirin-resistant patients differed from aspirin nonresistant patients in age, p = 0.004, 0.04, 0.02, respectively). In a multivariate model patients aged 76 years and more would likely to be aspirin resistant with odds ratio = 9 (95% confidence interval: 1-78). Conclusions: Patients aged 76 and more can be more likely aspirin resistant than younger patients. We believe that especially in the elderly with congestive heart failure there is a strong need for further investigations in this field, including searching for alternative antiplatelet therapies.

Evaluation and subgroup analysis of the efficacy and safety of intensive rosuvastatin therapy combined with dual antiplatelet therapy in patients with acute ischemic stroke

“…Aspirin has an irreversible inhibitory effect on platelet aggregation through acetylated platelet cyclooxygenase, while clopidogrel, as an adenosine diphosphate receptor inhibitor, inhibits platelet aggregation. For patients who took antiplatelet agents regularly and still had AIS, the possible cause was aspirin resistance [ 54 ] or clopidogrel resistance [ 55 ], which may explain that the study treatment can only reduce the risk of recurrent stroke significantly in patients of the subgroup of non-antiplatelet, but not in patients of the subgroup of prior-antiplatelet.…”

Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

“…4 In clinical practice, some patients still suffer from malignant cardio-cerebral vascular incidents after regular administration of aspirin. 5,6 Some studies found that factors such as age and underlying disease are associated with the potency of aspirin. In contrast, bleeding events occurred in some patients during medication due to the strong antiplatelet effect.…”