Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis

doi:10.1136/bmj.39430.529549.BE

BMJ 2008;336:195-198 (26 January), doi:10.1136/bmj.39430.529549.BE (published 17 January 2008)

Research

Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis

George Krasopoulos, cardiovascular surgery fellow¹, Stephanie J Brister, associate professor¹, W Scott Beattie, R Fraser Elliot chair in cardiac anaesthesia², Michael R Buchanan, professor³

¹ University Health Network, Division of Cardiovascular Surgery, Toronto General Hospital, ² University Health Network, Department of Anaesthesiology, Toronto General Hospital, ³ McMaster University, Department of Pathology and Molecular Medicine, Hamilton, ON, Canada L8S 4L8

Correspondence to: M R Buchanan mbuchan{at}mcmaster.ca

Objective To determine if there is a relation between aspirin"resistance" and clinical outcomes in patients with cardiovasculardisease.

Design Systematic review and meta-analysis.

Data source Electronic literature search without language restrictionsof four databases and hand search of bibliographies for otherrelevant articles.

Review methods Inclusion criteria included a test for plateletresponsiveness and clinical outcomes. Aspirin resistance wasassessed, using a variety of platelet function assays.

Results 20 studies totalling 2930 patients with cardiovasculardisease were identified. Most studies used aspirin regimens,ranging from 75-325 mg daily, and six studies included adjunctantiplatelet therapy. Compliance was confirmed directly in 14studies and by telephone or interviews in three. Informationwas insufficient to assess compliance in three studies. Overall,810 patients (28%) were classified as aspirin resistant. A cardiovascularrelated event occurred in 41% of patients (odds ratio 3.85,95% confidence interval 3.08 to 4.80), death in 5.7% (5.99,2.28 to 15.72), and an acute coronary syndrome in 39.4% (4.06,2.96 to 5.56). Aspirin resistant patients did not benefit fromother antiplatelet treatment.

Conclusion Patients who are resistant to aspirin are at a greaterrisk of clinically important cardiovascular morbidity long termthan patients who are sensitive to aspirin.

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Rapid Responses:

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