Abstract
BackgroundOur previous publication showed that 9% of patients with a history of myocardial infarction MI. could be labeled as aspirin resistant; all of these patients were aspirin resistant because of non-compliance. This report compares the relative frequency of aspirin resistance between known compliant and non-compliance subjects to demonstrate that non-compliance is the predominant cause of aspirin resistance.MethodsThe difference in the slopes of the platelet prostaglandin agonist (PPA) light aggregation curves off aspirin and 2 hours after observed aspirin ingestion was defined as net aspirin inhibition.ResultsAfter supposedly refraining from aspirin for 7 days, 46 subjects were judged non-compliant with the protocol. Of the remaining 184 compliant subjects 39 were normals and 145 had a past history of MI. In known compliant subjects there was no difference in net aspirin inhibition between normal and MI subjects. Net aspirin inhibition in known compliant patients was statistically normally distributed. Only 3% of compliant subjects (2 normals and 5 MI) had a net aspirin inhibitory response of less than one standard deviation which could qualify as a conservative designation of aspirin resistance. A maximum of 35% of the 191 post MI subjects could be classified as aspirin resistant and/or non-compliant: 9% aspirin resistant because of non-compliance, 23% non-compliant with the protocol and possibly 3% because of a decreased net aspirin inhibitory response in known compliant patients.ConclusionOur data supports the thesis that the predominant cause of aspirin resistance is noncompliance.
Highlights
Our previous publication showed that 9% of patients with a history of myocardial infarction MI. could be labeled as aspirin resistant; all of these patients were aspirin resistant because of non-compliance
Of the 230 subjects 45 were excluded from the analysis of compliant subjects because their off aspirin aggregation responses to arachidonic acid (AA) were less than 50% of maximal and one patient who admitted to violating the protocol's stipulation not to take NANSAIDs
No difference was observed between the 39 normal subjects and the 145 myocardial infarction patients for platelet prostaglandin agonist (PPA) aggregation slopes off and on aspirin or for net aspirin inhibition (p = 0.61)
Summary
Our previous publication showed that 9% of patients with a history of myocardial infarction MI. could be labeled as aspirin resistant; all of these patients were aspirin resistant because of non-compliance. Our previous publication showed that 9% of patients with a history of myocardial infarction MI. Could be labeled as aspirin resistant; all of these patients were aspirin resistant because of non-compliance. A daily aspirin delays the progression of occlusive atherosclerotic vascular disease [1,2,3,4,5]. Patients with a history of myocardial infarction who are taking aspirin have a 25%. Decrease in adverse vascular events while patients with increasing symptoms of angina have a 50% decrease in vaso-occlusive events with aspirin therapy [6,7,8]. Five studies and two metaanalysis show that patients with, "aspirin resistance", have a more rapid progression of their atherosclerotic disease [14,15,16,17,18,19,20]
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