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Letter| Volume 119, ISSUE 3, P287-288, March 2006

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Reply to “Comments in response to Low-dose aspirin increases aspirin resistance in patients with coronary artery disease”

      The Reply:
      We would like to thank Drs Fisher and Knappertz for their interest in our study.
      • Lee P.Y.
      • Chen W.H.
      • Ng W.
      • et al.
      Low-dose aspirin increases aspirin resistance in patients with coronary artery disease.
      The relationship of aspirin resistance and adverse cardiovascular events has been reported in several studies.
      • Mueller M.R.
      • Salat A.
      • Stangl P.
      • et al.
      Variable platelet response to low-dose ASA and the risk of limb deterioration in patients submitted to peripheral arterial angioplasty.
      • Eikelboom J.W.
      • Hirsh J.
      • Weitz J.I.
      • Johnston M.
      • Yi Q.
      • Yusuf S.
      Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events.
      • Gum P.A.
      • Kottke-Marchant K.
      • Welsh P.A.
      • White J.
      • Topol E.J.
      A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease.
      • Chen W.H.
      • Lee P.Y.
      • Ng W.
      • Tse H.F.
      • Lau C.P.
      Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment.
      One of those is our observation on the increased risk of myonecrosis following elective percutaneous coronary intervention among aspirin-resistant patients measured by the same device used in the current study.
      We agree that there may be potential ethnic differences in the response to aspirin, and extrapolating our findings to a different population should be made with caution. We are aware of the study by Maree et al on the increased likelihood of heavier patients to have an inadequate response to the platelet inhibitory effect of aspirin.
      • Maree A.O.
      • Curtin R.J.
      • Dooley M.
      • et al.
      Platelet response to low-dose enteric-coated aspirin in patients with cardiovascular disease.
      Differences in the methodology of measuring aspirin resistance may explain the disparity concerning the relationship of body weight and the prevalence of aspirin resistance.
      We fully agree that treatment compliance and coadministration of drugs having platelet inhibitory effect are important considerations in studies on aspirin resistance, and efforts should be made to eliminate these confounding factors.
      The inconsistency between our study and that from Wang et al,
      • Wang J.C.
      • Aucoin-Barry D.
      • Manuelian D.
      • et al.
      Incidence of aspirin nonresponsiveness using the Ultegra Rapid Platelet Function Assay-ASA.
      as mentioned in our discussion, is possibly due to the differences in the type of atherothrombotic disease affecting the studied populations and the pattern of prescribed aspirin dosage.

      References

        • Lee P.Y.
        • Chen W.H.
        • Ng W.
        • et al.
        Low-dose aspirin increases aspirin resistance in patients with coronary artery disease.
        Am J Med. 2005; 118: 723-727
        • Mueller M.R.
        • Salat A.
        • Stangl P.
        • et al.
        Variable platelet response to low-dose ASA and the risk of limb deterioration in patients submitted to peripheral arterial angioplasty.
        Thromb Haemost. 1997; 78: 1003-1007
        • Eikelboom J.W.
        • Hirsh J.
        • Weitz J.I.
        • Johnston M.
        • Yi Q.
        • Yusuf S.
        Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events.
        Circulation. 2002; 105: 1650-1655
        • Gum P.A.
        • Kottke-Marchant K.
        • Welsh P.A.
        • White J.
        • Topol E.J.
        A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease.
        J Am Coll Cardiol. 2003; 41: 961-965
        • Chen W.H.
        • Lee P.Y.
        • Ng W.
        • Tse H.F.
        • Lau C.P.
        Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment.
        J Am Coll Cardiol. 2004; 43: 1122-1126
        • Maree A.O.
        • Curtin R.J.
        • Dooley M.
        • et al.
        Platelet response to low-dose enteric-coated aspirin in patients with cardiovascular disease.
        J Am Coll Cardiol. 2005; 47: 1258-1263
        • Wang J.C.
        • Aucoin-Barry D.
        • Manuelian D.
        • et al.
        Incidence of aspirin nonresponsiveness using the Ultegra Rapid Platelet Function Assay-ASA.
        Am J Cardiol. 2003; 92: 1492-1494

      Linked Article

      • Comments in Response to “Low-Dose Aspirin Increases Aspirin Resistance in Patients with Coronary Artery Disease”
        The American Journal of MedicineVol. 119Issue 3
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          We read with great interest the recent article by Lee et al, “Low-Dose Aspirin Increases Aspirin Resistance in Patients with Coronary Artery Disease.”1 Using a novel point-of-care device, the authors report a significant association between aspirin dose and a failure to respond according to a predetermined aspirin resistance threshold. The use of this and other means and methods have been used to determine whether an appropriate response to aspirin has been achieved. Despite the number of studies, none has prospectively correlated aspirin resistance to an increased risk for cardiovascular events.
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