Aspirin Is Not Effective In All Cases Of Coronary Heart Disease

Two studies presented at the last American Heart Association Scientific Sessions, suggest that Aspirin should not be used or prescribed blindly for people suffering from Coronary Artery Disease. The reason for this is that these studies proved that there is not the hitherto presumed kind of uniformity in aspirin’s ability to reduce vascular events or its anti-platelet effect particularly in stroke patients.

Dr. Kandice Kottke-Marchant, head of haemostasis and thrombosis - department of clinical pathology at the Cleveland Clinic, and her colleagues evaluated, through a series of blood tests and clinical observation, 328 patients with stable cardiovascular disease who were taking 325 mg/day of aspirin for at least seven days. The platelet function analyser test (PFA100) can rapidly screen a large number of patients for aspirin-resistance and is a sensitive test. This test showed that 9.1% patients were resistant to aspirin. These patients tended to be slightly younger while those that were semi-responders to aspirin were slightly older. Also the higher proportion of the population among both the aspirin resistant and semi-responders were females compared with the aspirin sensitive patients who were men and also more likely to be smokers!

Another study was carried out at the University of Maryland, Baltimore by Dr. Maribeth Friend and colleagues on 63 patients with Coronary Artery Disease (CAD) who were taking 325 mg/day of aspirin. They found that those who had high cholesterol were less responsive to aspirin than those whose cholesterol was within normal limits. In other words 57% of the patients with total cholesterol more than 220 mg/dL were poor responders to aspirin compared with only 20% with levels less than 180mg/dL.

Subsequent to these studies, it was recommended that alternative anti-platelet drugs be advised for patients with reduced platelet responsiveness to aspirin. For this a thorough work-up of each patient specifically for this purpose would be required and could in fact be requested by the patients themselves before they start taking aspirin on a regular basis.

Source: Cardiology Today , Vol. 4, No. 2.

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