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Prevalence of high on-treatment platelet reactivity in diabetic patients treated with aspirin
Scot H Simpson1, Ahmed S Abdelmoneim1, Dima Omran1
1Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.
Insights
Diabetic patients taking low-dose aspirin (≤100 mg) have a higher prevalence of high on-treatment platelet reactivity (HTPR), suggesting aspirin may be less effective for cardiovascular prevention in this population. Higher doses may be needed.
Area of Science:
- Cardiology
- Pharmacology
- Diabetes Mellitus Research
Background:
- Randomized controlled trials indicate low-dose aspirin (≤100 mg daily) is ineffective for primary cardiovascular event prevention in diabetes.
- Clinical evidence suggests higher aspirin doses may be required for adequate antiplatelet activity in diabetic patients.
- High on-treatment platelet reactivity (HTPR) is a potential reason for aspirin's ineffectiveness, but its prevalence in diabetes is unknown.
Purpose of the Study:
- To systematically review the relationship between daily aspirin dosage and the prevalence of HTPR in patients with diabetes.
- To determine the prevalence of HTPR in diabetic patients compared to non-diabetic individuals.
- To assess if aspirin dosage influences HTPR prevalence in diabetes.
Main Methods:
- A systematic review of three electronic databases was conducted, searching for studies on aspirin, resistance, and diabetes until May 2013.
- Studies reporting HTPR prevalence based on daily aspirin dose and diabetes status were included.
- Weighted mean prevalence and pooled relative risks (RR) were calculated using a random-effects model.
Main Results:
- Data from 31 studies involving 2147 diabetic patients were analyzed.
- The overall prevalence of HTPR was 21.9% in diabetic patients versus 15.8% in non-diabetic patients (RR 1.36).
- HTPR prevalence was dose-dependent: 23.6% for ≤100 mg aspirin daily versus 12.3% for 101-325 mg daily (RR 1.70).
Conclusions:
- Approximately one in four diabetic patients may experience HTPR with commonly used aspirin doses (≤100 mg).
- This high prevalence of HTPR could significantly impact the effectiveness of aspirin for cardiovascular event prevention in diabetes.
- Further clinical trials are warranted to verify these findings and explore optimal aspirin dosing strategies for diabetic patients.
Background:
Randomized controlled trials have shown that ≤ 100 mg aspirin daily is not effective for primary prevention of cardiovascular events in diabetes; however, clinical and pharmacologic evidence suggests these patients need >100 mg for adequate antiplatelet activity. Although high on-treatment platelet reactivity (HTPR) could explain the lack of benefit, prevalence of HTPR in diabetes is not known. This systematic review examined the relationship between daily aspirin dose and prevalence of HTPR in patients with diabetes.
Methods:
Three electronic databases were searched until May 2013 using database-appropriate terms for aspirin, resistance, and diabetes. Studies were included if prevalence of HTPR was reported according to daily dose and diabetes status. Patients were stratified by daily aspirin dose and the weighted mean prevalence across studies was calculated. Where appropriate, pooled relative risks (RR) were calculated using a random-effects model.
Results:
Data were available from 31 studies that enrolled 2147 diabetic patients. Overall, prevalence of HTPR was 21.9% (95% confidence interval [CI], 15.2%-28.5%) in diabetic patients and 15.8% (95% CI, 11.4%-20.3%) in nondiabetic patients (pooled RR 1.36; 95% CI, 1.08-1.71; I(2) 56%). Prevalence appeared to be dose related, with 398 (23.6%) of 1689 diabetic patients using ≤ 100 mg daily having HTPR compared with 64 (12.3%) of 518 diabetic patients using 101-325 mg daily (pooled RR 1.70; 95% CI, 1.07-2.72; I(2) 0%).
Conclusions:
Although these observations should be verified in a clinical trial, the possibility that 1 in 4 patients have HTPR with doses commonly used in diabetes could have significant implications on overall effectiveness of aspirin.
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