Current evidence and clinical implications of aspirin resistance.
Atherothrombosis, characterized by atherosclerotic plaque rupture and subsequent occlusive or subocclusive thrombus formation is the primary cause of acute ischemic syndromes involving all vascular beds and accounts for more than one-third of all deaths in the developed world. Platelet activation and aggregation constitute the most critical component in the pathophysiology of atherothrombotic disease. Aspirin is currently the most commonly used antiplatelet agent and one of the most frequently prescribed drugs, with as many as 30 million Americans on chronic aspirin regimens. Multiple well-designed prospective randomized clinical trials have demonstrated aspirin's efficacy in both primary and secondary prevention of a wide variety of entities that the atherothrombotic disease spectrum encompasses, such as cerebrovascular, coronary artery, and peripheral vascular disease. Despite its proven benefit, however, a growing body of evidence suggests that up to 70% of aspirin-takers may still be at risk for atherothrombotic complications due to resistance. Patients with laboratory-confirmed aspirin resistance seem to have an almost fourfold increase in their risk for acute thrombotic episodes, which underlines the magnitude of the problem for the vascular specialist. In this article, we review the physiology of platelet activation and the role of aspirin as an antiplatelet agent; the various laboratory assays used in assessing aspirin effectiveness; and current data on aspirin resistance and its clinical implications in patients with cardiovascular disease. We also review the studies that explore this phenomenon in patients with peripheral arterial disease and discuss the optimal management options in aspirin-resistant individuals. Suggestions are advanced for the direction of future trials evaluating aspirin resistance in patients with vascular disease.
Kasotakis
George
G
Department Surgery, Creighton University Medical Center, Omaha, Neb, USA.
Pipinos
Iraklis I
II
Lynch
Thomas G
TG
D001241:Aspirin / Q000266:history / Q000627:therapeutic use*; D001760:Bleeding Time; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000266:history / Q000627:therapeutic use*; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049690:History, Ancient; D006801:Humans; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000266:history / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D014656:Vascular Surgical Procedures / Q000009:adverse effects
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin