Enhanced Platelet Reactivity under Aspirin Medication and Major Adverse Cardiac and Cerebrovascular Events in Patients with Coronary Artery Disease.

Abstract

Aspirin is indispensable in secondary prevention of ischemic events in patients with coronary artery disease (CAD). However, insufficient platelet inhibition despite aspirin medication is frequent. This is referred to as high on-treatment platelet reactivity (HTPR). Nevertheless, if this is associated with clinical outcome instead of only laboratory phenomenon remains unclear so far. In this study, we test whether patients with ischemic events have higher platelet reactivity despite aspirin medication than patients without ischemic events. In this prospective study of 72 CAD patients, we determined pharmacodynamic response to aspirin by arachidonic acid induced aggregation via light-transmission aggregometry and expressed as maximum of aggregation (MoA). During a mean follow-up duration of 3.2 years, major adverse cardiac and cerebrovascular events (MACCE), mortality, non-ST-elevation myocardial infarction (NSTEMI), and stroke were assessed as endpoints via yearly telephone interviews with the treating physician of the patients. Patients who suffered from MACCE, death, and NSTEMI had a significantly higher MoA than those without (MACCE: 5.4 vs. 16.4%, p < 0.05; death: 5.6 vs. 16.8%, p < 0.05; NSTEMI: 1.8 vs. 21%, p < 0.001). MoA did not differ with regard to the occurrence of stroke (10.1 vs. 14.9%, p = 0.59). Patients with MACCE, death, and NSTEMI show enhanced platelet reactivity despite aspirin medication as compared to patients without ischemic events. Hence, insufficient response to aspirin medication should be regarded as risk factor for ischemic events in CAD patients. Further trials are needed to assess options to overcome HTPR to aspirin.

• Authors: Lisa Dannenberg, Daniel Metzen, Saif Zako, Martin Pöhl, Philipp Mourikis, Carolin Helten, Kajetan Trojovsky, David Naguib, Daniel Konsek, Betül Knoop, Aysel Ayhan, Thomas Hohlfeld, Tobias Petzold, Bodo Levkau, Verena Veulemans, Tobias Zeus, Malte Kelm, Amin Polzin
• Journal: Pharmacology (Pharmacology) Vol. 105 Issue 1-2 Pg. 118-122 ( 2020) ISSN: 1423-0313 [Electronic] Switzerland
• PMID: 31639801 (Publication Type: News, Observational Study)
• Copyright: © 2019 S. Karger AG, Basel.

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Aspirin (therapeutic use)
• Blood Platelets (drug effects, physiology)
• Coronary Artery Disease (drug therapy, epidemiology)
• Female
• Humans
• Male
• Myocardial Infarction (epidemiology)
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (therapeutic use)
• Stroke (epidemiology)