Editorials

Aspirin resistance

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7438.477 (Published 26 February 2004) Cite this as: BMJ 2004;328:477
  1. Graeme J Hankey, consultant neurologist (gjhankey@cyllene.uwa.edu.au),
  2. John W Eikelboom, consultant haematologist
  1. Stroke Unit, Department of Neurology, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6001, Australia
  2. Department of Haematology, Royal Perth Hospital

    May be a cause of recurrent ischaemic vascular events in patients taking aspirin

    Aspirin reduces the odds of serious atherothrombotic vascular events and death in a broad category of high risk patients by about one quarter.1 The primary antithrombotic mechanism is believed to be inhibition of the biosynthesis of thromboxane (and thus platelet activation) by inactivation of platelet cyclo-oxygenase-1. However, aspirin is not that effective. It still fails to prevent most (at least 75%) serious vascular events in patients with symptomatic atherothrombosis.1 Recurrent vascular events in patients taking aspirin (“aspirin treatment failures”) have many possible causes (box), and aspirin resistance has emerged as an additional contender.2 3

    But what is aspirin resistance? Aspirin resistance has been used to describe several different phenomena. One is the inability of aspirin to protect patients from ischaemic vascular events. This has also been called clinical aspirin resistance.4 However, this definition is non-specific and could apply to any of the conditions listed in the box. Furthermore, it is not realistic to expect that all vascular complications can be prevented by any single preventive strategy.5 Aspirin resistance has also been used to describe an inability of aspirin to produce an anticipated effect on one or more tests of …

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