BMJ, 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 cardiovascular disease.

Design Systematic review and meta-analysis.

Data source Electronic literature search without language restrictions of four databases and hand search of bibliographies for other relevant articles.

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

Results 20 studies totalling 2930 patients with cardiovascular disease were identified. Most studies used aspirin regimens, ranging from 75-325 mg daily, and six studies included adjunct antiplatelet therapy. Compliance was confirmed directly in 14 studies and by telephone or interviews in three. Information was insufficient to assess compliance in three studies. Overall, 810 patients (28%) were classified as aspirin resistant. A cardiovascular related 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 from other antiplatelet treatment.

Conclusion Patients who are resistant to aspirin are at a greater risk of clinically important cardiovascular morbidity long term than patients who are sensitive to aspirin.


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