Predictors of successful acetylsalicylic acid resistance suppression after percutaneous coronary revascularisation

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Management of acetylsalicylic acid (ASA) resistance in coronary artery disease (CAD) lacks established protocols.
• Investigating the efficacy of increased ASA dosage is crucial for patients with suboptimal response.

Purpose of the Study:

• To evaluate if doubling the daily dose of aspirin (75 mg to 150 mg) can overcome aspirin resistance in patients with coronary artery disease.
• To identify predictors of successful aspirin resistance suppression.

Main Methods:

• A study involving 40 coronary artery disease patients with confirmed aspirin resistance (ARU ≥ 550) to 75 mg daily aspirin.
• Patients were treated with 150 mg daily aspirin for four weeks, with reassessment of aspirin reaction units (ARU) to determine sensitivity.
• Multivariate and ROC analyses were used to identify predictors of successful resistance overcoming.

Main Results:

• Aspirin resistance was successfully overcome in 62.5% of patients treated with 150 mg daily aspirin.
• Independent predictors for successful aspirin resistance suppression included male gender and lower baseline ARU values (≤ 608) on 75 mg aspirin.
• A predictive model using male gender and initial ARU ≤ 608 showed increasing success rates (8%, 36%, 56%) with zero, one, or two predictors present.

Conclusions:

• Doubling the aspirin dose is an effective strategy for overcoming aspirin resistance in a significant portion of coronary artery disease patients.
• Male patients and those with lower initial ARU values are more likely to regain aspirin sensitivity with increased dosage.
• These findings support personalized approaches to managing aspirin resistance based on patient characteristics.