Microembolic signals and aspirin resistance in patients with carotid stenosis
Jesse Dawson1, Terry Quinn, Kennedy R Lees
1Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinaryand Life Sciences, University of Glasgow, Western Infirmary, Glasgow, G11 6NT, UK. jesse.dawson@glasgow.ac.uk
Insights
Aspirin resistance is more common in patients with carotid artery disease and microembolic signals (MES), a stroke risk marker. This suggests aspirin resistance may contribute to stroke risk in these individuals.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Aspirin resistance is a potential contributor to cardiovascular events.
- Microembolic signals (MES) are measurable markers indicating increased stroke risk.
- Internal carotid artery (ICA) disease is a significant risk factor for stroke.
Purpose of the Study:
- To investigate the association between aspirin resistance and the presence of MES in patients with ICA disease.
- To determine if aspirin resistance is more prevalent in patients with MES.
Main Methods:
- Study included patients with significant ICA disease on aspirin therapy.
- Monitored for MES and assessed aspirin resistance using PFA-100 and Verify-Now systems.
- Compared aspirin resistance rates between patients with and without MES.
Main Results:
- 25.8% of patients exhibited aspirin resistance.
- Aspirin resistance was significantly more common in patients with MES (50%) compared to those without (17.4%).
- Moderate agreement was observed between different platelet function tests.
Conclusions:
- Aspirin resistance is more frequent in carotid disease patients with MES.
- Further research is needed to explore if screening for aspirin resistance and adjusting antiplatelet therapy can reduce MES and stroke risk.
Introduction And Aims:
Aspirin resistance may be linked to increased risk of cardiovascular events. We aimed to evaluate whether it was associated with presence of microembolic signals (MES), a readily measurable marker of increased stroke risk, in those with internal carotid artery (ICA) disease.
Methods:
We studied patients with significant ICA disease who were compliant with aspirin therapy. We performed monitoring for MES and measured aspirin resistance status, using the platelet function analyzer (PFA)-100 and Verify-Now systems. We compared frequency of aspirin resistance between patients with and without MES and assessed agreement between the different platelet function tests.
Results:
We recruited 62 patients. Most (53, 85.5%) had symptomatic carotid disease and 16 (25.8%) had MES. The rate of aspirin resistance on at least one test was 25.8% (16 patients), with 13 (21%) resistant on PFA-100 testing, 8 (12.9%) using the Verify-Now system and 5 (8.1%) resistant on both. Aspirin resistance was more common in patients with MES (50% compared to 17.4% without, P= 0.018 on Fisher's exact test). Agreement between the platelet function tests was moderate (к= 0.41).
Conclusion:
Aspirin resistance appears more common in patients with carotid disease who have MES compared to those without. Further work should aim to establish whether screening for aspirin resistance and subsequent adjustment to antiplatelet therapy reduces the rate of MES and stroke risk in those with carotid disease.
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