Stroke, Vol 25, 2331-2336, Copyright © 1994 by American Heart Association
CM Helgason, KM Bolin, JA Hoff, SR Winkler, A Mangat, KL Tortorice and LD Brace
BACKGROUND AND PURPOSE: The ex vivo effect of aspirin (ASA) on platelet
aggregation, the platelet component of thrombosis, was studied at repeated
intervals in a cohort of patients taking aspirin for recurrent ischemic
stroke prevention to define the maintenance of efficacy over time. METHODS:
We administered increasing doses of aspirin (from 325 to 1300 mg/d) to
patients with previous ischemic stroke and determined the extent of
inhibition of platelet aggregation after 2 weeks and thereafter at
approximately 6-month intervals. RESULTS: Over 33 months, 306 patients had
platelet aggregation studies performed to define their initial response to
ASA therapy. Of these, 228 had complete and 78 had partial inhibition of
platelet aggregation at initial testing. To date, 119 of those who had
complete inhibition and 52 who had partial inhibition have undergone repeat
testing at least once. At repeat testing 39 of the 119 (32.7%) with
complete inhibition at initial testing had lost part of the antiplatelet
effect of ASA and converted from complete to partial inhibition without
change in ASA dosage. Of the 52 with partial inhibition at initial testing,
35 achieved complete inhibition either by ASA dosage escalation (in 325
mg/d increments) or fluctuation of response at the same dosage, but 8 of
those 35 (22.8%) had reverted to partial inhibition when tested again.
Overall, 8.2% of patients ultimately exhibited ASA resistance to 1300
mg/d-8 of 52 (15.4%) with partial inhibition and 6 of 119 (5.0%) with
complete inhibition at initial testing. CONCLUSIONS: The antiplatelet (and
presumably the antithrombotic) effect of a fixed dose of ASA is not
constant over time in all individuals. The mechanisms by which increased
dosage requirement or ASA resistance develops and the clinical significance
of this development are currently undefined.
ARTICLES
Development of aspirin resistance in persons with previous ischemic stroke
University of Illinois at Chicago, Department of Neurology, IL.
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