title: "Aspirin - resistance"? A few critical considerations on definition, terminology, diagnosis, clinical value, natural course of atherosclerotic disease, and therapeutic consequences.
abstract: Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term "aspirin resistance" was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Interest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Therefore, it may be more appropriate to speak about "treatment failure" to aspirin therapy than using the term "aspirin resistance". There is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term "aspirin resistance" should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended.
authors.affiliation: Center for Cardiovascular Rehabilitation, Rehabilitationszentrum, Bad Schallerbach, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Berent
authors.forename: H
authors.initials: H
authors.lastname: Sinzinger
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000097:blood* / Q000188:drug therapy*; D001760:Bleeding Time; D004351:Drug Resistance; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D010974:Platelet Aggregation / Q000187:drug effects*; D019095:Point-of-Care Systems; D017211:Treatment Failure
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin