The role of aspirin resistance in the treatment of acute coronary syndromes.
The TIMI Risk Score recognizes prior aspirin use as an independent risk factor for adverse outcomes in subjects presenting with an acute coronary syndrome. The etiology of this increased risk awaits clarification, but prior aspirin use may be associated with altered thrombus composition which is more resistant to current treatment modalities as compared to thrombus formation in subjects without prior aspirin use. Post hoc analysis of acute coronary syndrome trials has shown that prior aspirin users treated with unfractionated heparin are at particularly high risk. The addition of glycoprotein IIb/IIIa receptor inhibitor to unfractionated heparin or substitution of low-molecular-weight heparin significantly improves outcomes in prior aspirin users. The prognostic significance of prior aspirin use in acute coronary syndromes has important implications not only in clinical practice, but also in the design and interpretation of clinical trials.
Lancaster
Gilead I
GI
Department of Medicine, Division of Cardiovascular Medicine, Department of Medicine, Bridgeport Hospital, Bridgeport, Connecticut 06610, USA. pglanc@bpthosp.org
Jain
Hitender
H
Zarich
Stuart W
SW
D000208:Acute Disease; D001241:Aspirin / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013577:Syndrome; D016896:Treatment Outcome