Aspirin resistance: moving forward with multiple definitions, different assays, and a clinical imperative

Many patients are treated with aspirin to prevent a serious vascular event, most notably myocardial infarction and stroke. A growing number of studies have been appearing in the literature that indicate a significant fraction of aspirin-treated patients may be resistant to the antiplatelet effects of the drug. Resistance to aspirin may be related to the concomitant ingestion of aspirin and nonsteroidal anti-inflammatory drugs, which impairs the aspirin effect, or to more complex situations, such as metabolic defects that diminish the therapeutic effect of aspirin. The incidence of aspirin resistance is unknown, but it may approach 20% to 30%. The diagnosis of aspirin resistance has been evaluated using multiple assays, and because there are multiple assays, this has resulted in multiple definitions for aspirin resistance. This review considers aspirin resistance at a time when there is confusion about the definition, and the clinical assay to best assess it, because there is a clinical imperative to know now which patients taking aspirin are not receiving a therapeutic effect.