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Aspirin resistance: does it exist?

Gundu H R Rao¹, Jan Jaques Michiels

¹Laboratory Medicine & Pathology, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA.

Seminars in Thrombosis and Hemostasis

|March 7, 2007

Summary

Aspirin resistance is likely a myth, often caused by incorrect aspirin dosage or non-adherence. Accurate testing for aspirin sensitivity requires specific laboratory methods targeting cyclooxygenase-1 inhibition.

Area of Science:

Pharmacology
Cardiovascular Medicine
Clinical Chemistry

Background:

Aspirin irreversibly inhibits platelet cyclooxygenase-1 (COX-1), a key enzyme in platelet activation.
Aspirin sensitivity is traditionally assessed by measuring the inhibition of arachidonic acid (AA)-induced platelet aggregation.
The concept of 'aspirin resistance' has emerged, suggesting some individuals do not benefit from aspirin therapy.

Purpose of the Study:

To critically evaluate the definition and existence of aspirin resistance.
To propose accurate laboratory methods for assessing aspirin sensitivity.
To clarify the confounding factors contributing to perceived aspirin resistance.

Main Methods:

Review of existing literature on aspirin's mechanism of action and platelet function tests.

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Analysis of the definition of aspirin resistance based on COX-1 inhibition.

Discussion of specific laboratory tests for aspirin sensitivity, including AA-induced platelet aggregation and malondialdehyde production.

Main Results:

Aspirin resistance, defined as the inability to inhibit COX-1, likely does not exist.
Perceived aspirin resistance is frequently attributable to patient noncompliance or inadequate aspirin dosage.
Nonspecific platelet function tests may lead to misinterpretation and confusion regarding aspirin resistance.

Conclusions:

Accurate assessment of aspirin sensitivity requires specific laboratory tests that directly measure COX-1 inhibition.
The phenomenon of aspirin resistance is often a misinterpretation of noncompliance or incorrect dosing.
Further research should focus on standardized, specific tests for aspirin sensitivity in clinical practice.