Dear ALL
Some people using aspirin as loprin or other coated formulations with underlying ASCVD(Atherosclerotic cardiovascular disease) still end up having accelerated atherosclerotic diseases.
Resistance to aspirin is a documented phenomena.
Reference:
1- Wang CW et al. Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients. Brain Res Bull. 2018 Jul 23;142:176-182. doi: 10.1016/j.brainresbull.2018.07.004.
2- Zheng AS et al. Association of aspirin resistance with increased stroke severity and infarct size. JAMA Neurol. 2013 Feb;70(2):208-13. doi: 10.1001/jamaneurol.2013.601.
3- Cheng X et al. Biochemical aspirin resistance is associated with increased stroke severity and infarct volumes in ischemic stroke patients. Oncotarget. 2017 Aug 18;8(44):77086-77095. doi: 10.18632/oncotarget.20356. eCollection 2017 Sep 29.
So what are your comments?
How do we clinically suspect that?
Any simple test to measure aspirin resistance?
Regards
We should test platelet aggregation weather aspirin is working well. Clinically, there may not be any definite signs of of that issue, however most patients with it are more likely thrombotic events.
Thanks a lot Jamol
Yes it platelet aggregation tests, I guess are the standard test to date to diagnose aspirin resistance. Issues with these test remain non-availability in most set ups, feasibility in terms of precision and probably cost. Moreover, the test requests are minimal to allow more commercial input into this category of test.
So apart from treating physician acumen I guess not much remains available as a practical biomarker or surrogate marker to diagnose this conditions. May be in the incoming onslaught of molecular tests may change the scenario.
Jamol! My question pertain to how many such cases do suspect or diagnose in clinical set ups? Or do you have some local/regional data to share on the percentage of aspirin resistance?
How many times you have resorted to these platelet aggregation tests? as one PhD student told me that the yield of diagnosing aspirin resistance with conventional aggregation tests is quite low.
And do you know of simple or other molecular tests which could be incorporated to detect such cases?
My interpretation is whether the condition is either very rare OR the molecular defects are yet to be appropriately and completely diagnosed? OR the condition being poorly understood and thus underdiagnosed.
Warm regards
Dr Sikandar
It should borne in mind that atherosclerosis is a disease with multiple risk factors and genetic associations. Aspirin may therefore not be the only culprit among those with accelerated disease. Other potential risk factors should be evaluated and treated.
I think there are different data regarding that issue according to geographical region, ethnicity, duration of the treatment and co-morbidities. In our practice we can diagnose 2-3 cases per month. Regarding platelet aggregation test we resort it in 5-6 times a week. And also, I would recommend genetic testing for GPIa, P2Y1. In my point of view, the condition was undiagnosed in some clinical set ups.
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