Randomized controlled trial comparing impact on platelet reactivity of twice‐daily with once‐daily aspirin in people with Type 2 diabetes

Abstract

In Type 2 diabetes, aspirin 100 mg twice daily reduced platelet reactivity more effectively than 100 mg once daily, and numerically more than 200 mg once daily. Clinical outcome trials evaluating primary cardiovascular disease prevention with aspirin in Type 2 diabetes may need to consider using a more frequent dosing schedule.

Aspirin in the prevention of cardiovascular events in patients with diabetes

“…Given the new insights into the pathophysiology underlying HTPR with aspirin in patients with diabetes, it is recommended that physicians consider alternative aspirin dosing regimens for appropriate patients with diabetes. Given the lack of outcomes data, it is suggested that the dose and frequency of aspirin administration should be made empirically, on the basis of the laboratory results of prospective, randomized trials [91,94,95,104,105] and patient potential for adherence and potential susceptibility to gastrointestinal upset. Unfortunately, outcomes, adherence and safety data from large, prospective studies of alternative aspirin dosing regimens are not currently available.…”

“…162 mg once daily vs. 162 mg twice daily (324 mg/day total dose) or 200 mg once daily vs. 200 mg twice daily (400 mg/day total dose)], [92,95] suggesting that this effect may plateau at certain daily dosages. [92,95] This plateau effect, combined with the possibility of dose-related aspirin adverse events, suggests that twice-daily dosing that augments the overall total dose of aspirin administered may not be ideal. However, studies in patients with diabetes and CVD who were on twice-daily aspirin dosing regimens without an increase in total daily dose (e.g.…”

Clinical Update: Cardiovascular Disease in Diabetes Mellitus

“…Several meta-analyses examining the effect of aspirin for primary prevention of ASCVD in diabetes have also been published 276–278 as well as a meta-analysis performed in the general population. 267 Intriguingly, early data suggest that twice daily dosing may increase the beneficial effect, 279,280 and support further study. However, the mechanism for potential greater benefit with twice daily aspirin dosing remains unclear as aspirin covalently modifies cyclooxygenase-1, leading to inhibition of platelet aggregation.…”

Aspirin in primary prevention for patients with diabetes: Still a matter of debate

“…3 Finally, more than 20 years ago, Winocour described that reduced platelet lifespan along with their increased turnover represented a powerful trigger to increase megakaryopoiesis in bone marrow, 32 as occurs in diabetes. [33][34][35][36] In fact, if on the one hand the production of prostaglandins is reduced, on the other hand this reduced production of prostaglandins may justify the augmented number of adverse effects, first among everything GI and intracranial bleeding. 33 In light of this finding, the increase of daily aspirin dose has been proposed to overwhelm aspirin resistance or pseudo-resistance with controversial results.…”