The Incidence and Methods for Detecting Aspirin Resistance in Pediatric Patients

Area of Science:

• Pediatric Cardiology
• Hematology
• Clinical Pharmacology

Background:

• Aspirin resistance can lead to severe complications like myocardial infarction or stroke, particularly in children.
• Assessing aspirin resistance in pediatric populations is infrequent, despite its clinical significance.
• Standard aggregometry is time-consuming, necessitating evaluation of rapid point-of-care alternatives.

Purpose of the Study:

• To determine the incidence of aspirin resistance in Thai children.
• To compare the efficacy of point-of-care platelet function analyzer (PFA-200) and bleeding time (BT) tests against standard impedance aggregometry (IA).
• To evaluate the role of routine aspirin resistance screening in pediatric patients.

Main Methods:

• A single-center cross-sectional study involving 37 Thai children (≤15 years) receiving aspirin.
• Comparison of platelet function analyzer (PFA-200) and bedside bleeding time (BT) with standard whole blood impedance aggregometry (IA).
• Aspirin resistance defined by IA (>5 ohms), PFA-200 (<180 seconds), and BT (≤7 minutes).

Main Results:

• Aspirin resistance was confirmed in 2.7% of pediatric patients via IA.
• PFA-200 demonstrated 100% sensitivity and 83.3% specificity, outperforming BT (36.1% specificity).
• PFA-200 and BT showed poor agreement with IA (McNemar P < 0.05, kappa values 0.215 and 0.030).

Conclusions:

• Aspirin resistance is rare in Thai children.
• Routine screening for aspirin resistance is generally not advised; consider it for recurrent thrombosis or resistant risk factors.
• PFA-200 shows potential as a point-of-care screening tool for pediatric aspirin resistance, unlike bedside BT.