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

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39430.529549.BE (Published 24 January 2008) Cite this as: BMJ 2008;336:195

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Hypothesis influences outcome

In the systematic review by Krasopoulos et al, it concluded that 28%
patients (810/2930) were classified as aspirin resistant and considered to
be at a greater risk of clinically important cardiovascular morbidity long
term.It is an interested and controversial topic indeed. From Table I
(Characteristics of included studies),I found out a big problem that the
data are origined from a variety of platelet function assays. However,
prevalences widely differ between studies reporting on aspirin resistance.
Both aspirin dosage and the method of defining aspirin resistance strongly
influence estimated prevalence [1].Moreover,the use of various agonists in
those platelet function assays directly influence the accuracy ofplatelet
reactivity assessment [2].In fact, the platelet aggregation should be a
normal ditribution among populations [3],and Aspirin responsiveness seem
to be the same as well. To define aspirin resistance based on such
circumstance should be more reasonable.

Krasopoulos et al. found that aspirin resistant patients did not benefit
from other antiplatelet treatment.It is also a controversial issue which
have been disscussed in my recent paper on Drugs Journal.

REFERENCE:

1.Hovens MM, Snoep JD, Eikenboom JC, van der Bom JG, Mertens BJ,
Huisman MV.Prevalence of persistent platelet reactivity despite use of
aspirin: a systematic review.Am Heart J. 2007;153:175-81.

2.Yee DL, Sun CW, Bergeron AL, Dong JF, Bray PF.Aggregometry detects
platelet hyperreactivity in healthy individuals.Blood. 2005;106:2723-9.

3.Gurbel PA, Bliden KP, Etherington A, Tantry US.Assessment of clopidogrel
responsiveness: measurements of maximum platelet aggregation, final
platelet aggregation and their correlation with vasodilator-stimulated
phosphoprotein in resistant patients.Thromb Res. 2007;121:107-15.

Competing interests:
None declared

Competing interests: No competing interests

06 March 2008
Yaozu Xiang
MD
Tianjin University of Traditional Chinese Medicine, 300193, Tianjin, China