In patients with cardiovascular dis...

In patients with cardiovascular disease, the use of aspirin has been shown to substantially abate ischemic vascular events through its antiplatelet activity. In a fresh meta-analysis of more than 200000 patients, aspirin was shown to model ischemic vascular events by 22 percent However, in certain bodys aspirin therapy does not provide an adequate antiplatelet activity. These patients have aspirin resistance, which is defined from platelet function testing and presum clinical unresponsiveness. This resistance has been reported in the literature, still little information links the laboratory documentation of aspirin resistance with clinical issues Gum and colleagues attempted to determine if aspirin resistance is associated with clinical events

The researchers careered a prospective trial of consecutive patients who readyed to an outpatient clinic between January 1997 and September 1999 To be included in the cogitation patients had to have a history of cardiovascular disease, like as myocardial infarction, stroke, documented coronary stenosis upon cardiac catheterization, or invasive cardiovascular revascularization step Patients who were at least 21 years of age were given 325 mg of aspirin as their simply antiplatelet medication during the contemplation Aspirin sensitivity was assessed at optical platelet aggregation. The primary consequence measures included myocardial infarction, cerebrovascular accident, and mortality. Mean follow-up time was 679 days.

Of the 326 patients listed in the study, 17 patients (52 percent) were raise to be aspirin resistant based forward laboratory evaluation using optical aggregation. Patients with aspirin resistance had a significantly increased risk of myocardial infarction, cerebrovascular accident, and mortality when compared with those who did not have aspirin resistance. A stratified multivariate analysis also identified aspirin resistance as independently associated with major adverse long-term outcomes

The authors end that aspirin resistance in a stable population comeed in a greater than threefold increase in the risk of major adverse circumstances They add that aspirin resistance is an important and real clinical diagnosis, and that with safe and effective alternative antiplatelet agents available, screening for aspirin resistance in cardiovascular patients is a useful tool.

KARL E MILLER, MD

Gum PA, et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol March 19 2003;41:961-5

COPYRIGHT 2003 American Academy of Family Physicians

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