Aspirin noncompliance is the major cause of "aspirin resistance" in patients undergoing coronary stenting.

Abstract

OBJECTIVES:

We investigated the hypothesis that biological aspirin "resistance" may often be related to noncompliance in patients undergoing coronary stenting.

BACKGROUND:

Premature discontinuation of antiplatelet therapy has been identified as a major risk factor for stent thrombosis and prior aspirin withdrawal has been associated with poor prognosis after acute coronary syndrome.

METHODS:

We prospectively investigated the occurrence of aspirin noncompliance in 136 consecutive patients undergoing coronary stenting receiving aspirin 75 mg daily. We analyzed posttreatment maximal intensity of arachidonic acid-induced platelet aggregation (AA-Ag) during hospitalization after controlled intake of aspirin and 1 month after hospital discharge. After 1 month, all "nonresponders" received controlled aspirin 75 mg and assessment of response was repeated. Aspirin nonresponse was defined by AA-Ag >30%.

RESULTS:

During inhospital period, the range of AA-Ag varied from 0% to 34% with a mean value of 7.5% +/- 10%, and 4 patients (3%) were classified as nonresponders. One month after discharge, AA-Ag of the population was significantly higher than during the hospital phase (15.3 +/- 23 vs 7.5 +/- 10%, P = .0004), and 19 patients (14%) were identified as nonresponders. After controlled administration of aspirin, all but one of these nonresponders became responders and were identified as patients with noncompliance rather than biological resistance.

CONCLUSION:

Aspirin resistance is rare in compliant patients using methods that directly indicate the degree of platelet cyclooxygenase inhibition. More than 10% of patients receiving aspirin for coronary stenting are noncompliant for aspirin therapy during the first month after stenting. These results suggest a need for improved education of these patients.

• Authors: Thomas Cuisset, Corinne Frere, Jacques Quilici, Bénédicte Gaborit, Laurent Bali, Raphaël Poyet, Dorothée Faille, Pierre Emmanuel Morange, Marie-Christine Alessi, Jean-Louis Bonnet
• Journal: American heart journal (Am Heart J) Vol. 157 Issue 5 Pg. 889-93 (May 2009) ISSN: 1097-6744 [Electronic] United States
• PMID: 19376317 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Acute Coronary Syndrome (surgery)
• Aged
• Aspirin (therapeutic use)
• Drug Resistance
• Female
• Follow-Up Studies
• France (epidemiology)
• Graft Occlusion, Vascular (epidemiology, etiology)
• Humans
• Incidence
• Inpatients
• Male
• Myocardial Revascularization (instrumentation)
• Patient Compliance
• Platelet Aggregation Inhibitors (therapeutic use)
• Prognosis
• Prospective Studies