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Effect of aspirin treatment in patients with peripheral arterial disease monitored with the platelet function
1Department of Internal Medicine, Division of Angiology, Karl Franzens University School of Medicine, Graz, Austria. Regina.Korninger@kfunigraz.ac.at
Insights
Aspirin (ASA) response varies in peripheral arterial disease (PAD) patients. The PFA-100TM test revealed 40% of PAD patients showed inadequate platelet inhibition with standard ASA dosage, suggesting potential treatment limitations.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Peripheral arterial disease (PAD) affects numerous patients, increasing cardiovascular risk.
- Aspirin (ASA) is a standard antiplatelet therapy for PAD, but its efficacy can vary.
- Assessing individual patient response to ASA is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate the effectiveness of aspirin (ASA) in patients with peripheral arterial disease (PAD).
- To investigate the variability in platelet inhibition in PAD patients treated with ASA using the PFA-100TM analyzer.
- To identify the proportion of PAD patients exhibiting an inadequate response to ASA therapy.
Main Methods:
- Utilized the Platelet Function Analyzer (PFA-100TM) to measure collagen and adenosine diphosphate closure time (CADP-CT) and collagen and epinephrine closure time (CEPI-CT).
- Recruited 31 previously untreated PAD patients, conducting tests before and after 7 days of 100 mg ASA daily.
- Excluded five patients due to non-compliance, von Willebrand disease, or NSAID use, analyzing 26 patients.
Main Results:
- Prior to ASA, mean CADP-CT was 90±15s and CEPI-CT was 116±27s.
- After 100 mg ASA daily, CADP-CT showed no significant change, but CEPI-CT significantly prolonged in all patients (226±82s).
- 40% of patients (10 out of 26) demonstrated an inadequate response to ASA, defined by CEPI-CT values not exceeding the normal range, with some requiring higher doses for effect.
Conclusions:
- A significant proportion of PAD patients (40%) may have an inadequate platelet inhibitory response to standard aspirin (ASA) therapy, as indicated by PFA-100TM CEPI-CT.
- The PFA-100TM test, specifically CEPI-CT, can identify PAD patients with suboptimal ASA response.
- Further research is warranted to determine if these non-responders experience reduced clinical benefit from aspirin and to explore alternative antiplatelet strategies.
Abstract:
We have used the platelet analyzer PFA-100TM to assess the effect of aspirin (ASA) in patients with documented peripheral arterial disease (PAD). Thirty-one previously untreated patients were recruited. Laboratory investigations, including the collagen and adenosine diphosphate closure time (CADP-CT) and the collagen and epinephrine closure time (CEPI-CT) were performed before and 7 days after treatment with 100 mg ASA per day. Five patients were excluded from the final analysis: one patient did not appear for second examination, in one patient type I von Willebrand disease was diagnosed, and three patients with prolonged CEPI-CT admitted the intake of non-steroidal anti-inflammatory drugs. Prior to ASA treatment, CADP-CT was 90 +/- 15 s (range, 67-124 s) and CEPI-CT was 116 +/- 27 s (range, 78-164 s). There was a significant negative correlation between CADP-CT and von Willebrand factor antigen (r = -0.57, P = 0.001). After treatment with 100 mg ASA per day, CADP-CT was not significantly different (96 +/- 22 s; range, 65-158 s). CEPI-CT, however, was prolonged in all patients, compared with pre-ASA values (226 +/- 82 s; range, 89 to > 300 s). In 12 of 26 patients, CEPI-CT was > 300 s and in another four of 26 patients CEPI-CT was prolonged to more than the upper normal range ('responders'). In the remaining 10 patients, CEPI-CT values did not exceed the upper limit of the normal range ('non-responders'). Five non-responders were re-investigated after intake of 300 mg ASA per day for 3 weeks; in none of these was a CEPI-CT > 165 s recorded. We conclude that 40% of PAD patients have an inadequate response to ASA, as determined by the PFA-100TM CEPI-CT. Whether these patients have a reduced benefit from this treatment remains to be investigated.
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