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| Major cardiac risk in aspirin-resistant patients |
21-Jan-2008 |
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From the print edition
BMJAspirin resistance, thought to affect up to one-third of patients, is associated with significantly increased cardiovascular morbidity, a comprehensive meta-analysis suggests.
The research, which analysed 20 studies including 2930 patients with cardiovascular disease, found aspirin-resistant patients had an almost sixfold increase in risk of death, were almost four times more likely to experience a cardiovascular event, and were at more than four times greater risk of acute coronary syndrome compared with non-resistant patients.
An accompanying editorial in the BMJ (online, 18 January) speculated on whether aspirin resistance represented a truly abnormal response to the drug or “whether it reflects normal variability in drug activity”.
Professor Phil Harris, head of cardiology at Sydney’s Royal Prince Alfred Hospital, said the latest data suggested research on the effect of aspirin on cardiovascular disease might have been compromised by treatment-resistant patients.
“Probably for those who do respond, the effect of aspirin is much more than we have assumed because the effects as have been measured in the past have been diluted out by the people who haven’t been responding,” he said.
Professor Harris said there was no agreement on what assays were best to detect resistance, and other antiplatelet agents such as clopidogrel and tirofiban did not provide any benefit in aspirin-resistant patients.
If a patient experienced an event while on low-dose aspirin, he suggested first increasing their dose. In patients with recurrent events while on aspirin, he said a haematological review to detect whether there was a problem with platelet function might be worthwhile, but options for management were very limited.
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Bianca Nogrady
BMJ 2008; online.
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