Elsevier

American Heart Journal

Volume 153, Issue 2, February 2007, Pages 175-181
American Heart Journal

Curriculum in Cardiology
Prevalence of persistent platelet reactivity despite use of aspirin: A systematic review

https://doi.org/10.1016/j.ahj.2006.10.040Get rights and content

Background

The absolute risk of recurrences among patients using aspirin for prevention of cardiovascular events remains high. Persistent platelet reactivity despite aspirin therapy might explain this in part. Reported prevalences of this so-called aspirin resistance vary widely, between 0% and 57%.

Objectives

The aim of the study was to systematically review all available evidence on prevalence of aspirin resistance and to study determinants of reported prevalence.

Methods

Using a predefined search strategy, we searched electronic databases MEDLINE, EMBASE, CENTRAL, and Web of Science. To be included in our analysis, articles had to contain a laboratory definition of aspirin resistance, use aspirin as secondary prevention, and report associated prevalence.

Results

We included 34 full-text articles and 8 meeting abstracts. The mean prevalence of aspirin resistance was 24% (95% CI 20%-28%). After adjustment for differences in definition, used dosage, and population, a statistically significant higher prevalence was found in studies with aspirin dosage ≤100 mg compared with ≥300 mg (36% [95% CI 28%-43%] vs 19% [95% CI 11%-26%], P < .0001). Studies measuring platelet aggregation using light aggregometry with arachidonic acid as an agonist had a pooled unadjusted prevalence of 6% (95% CI 0%-12%). In studies using point-of-care platelet function–analyzing devices, the unadjusted prevalence was significantly higher, at 26% (95% CI 21%-31%).

Conclusions

Prevalences widely differ between studies reporting on aspirin resistance. Both aspirin dosage and the method of defining aspirin resistance strongly influence estimated prevalence, which explains found heterogeneity among studies. On average, it appears that about 1 in 4 individuals may express biochemically defined aspirin resistance.

Section snippets

Methods

We used electronic databases to identify relevant reports. The following databases were searched using predefined search terms (Appendix A): MEDLINE (from January 1966 to October 2005), EMBASE (from January 1974 to October 2005), the Cochrane Central Register of Controlled Trials (from 1800 to 2005), and Web of Science. We used both MeSH terms and free text words. We used no language restrictions. Furthermore, we tried to identify additional studies by searching the reference lists of relevant

Results

We included 34 full-text articles and 8 meeting abstracts22, 23, 24, 25, 26, 27, 28, 29 in our systematic review (Figure 1). Overall, κ statistics were 0.82, indicating good interobserver agreement. The overall prevalence, weighted for study size, was 24% (95% CI 20%-28%), with prevalences ranging from 0%18 to 57%.19 There was a significant heterogeneity among studies (χ2 682.87, P < .00001, I2 94%). To explain this heterogeneity, we examined whether definition used, population studied, and

Discussion

Among studies on patients using aspirin for secondary prophylaxis of arterial thromboembolism included in our meta-analysis, the overall prevalence of laboratory-defined persistent platelet reactivity was approximately 25%. Prevalences widely differed between studies, which is largely explained by variance in method used to define aspirin resistance and dosage of aspirin used.

Analysis of unadjusted prevalence in studies using arachidonic acid–induced LTA shows a prevalence significantly lower

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