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ESC Congress 2003: Absent effect of aspirin in patients with acute myocardial infarction
September 01, 2003IMPORTANT: This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology
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Aspirin is given to patients at high risk of suffering an acute myocardial infarction in order to prevent this from happening. However, we have shown that in one third of patients suffering an acute myocardial infarction no platelet inhibiting effect of aspirin can be demonstrated.
The study was carried out at Odense University Hospital from 8th May 2002 to 23rd May 2003. We examined all patients admitted on suspicion of an acute myocardial infarction, and who prior to admission were on routine treatment with aspirin 150 mg daily. Immediately on hospital admission blood samples were taken from the 298 patients included in order to measure the platelet inhibiting effect of aspirin.
Despite being on treatment with aspirin almost one fourth of the patients experienced an acute myocardial infarction. Among the patients with acute myocardial infarction, we could not measure the expected effect of aspirin in 36%. In patients without acute myocardial infarction, a significantly smaller, but still considerable proportion (19%) also demonstrated an absent effect of aspirin.
The prognostic benefit of aspirin has been documented in several prior studies. However, over a two-year period one in ten patients will suffer a cardiovascular event despite daily aspirin therapy. In addition laboratory studies examining the platelet inhibiting effect of aspirin have shown a wide variability in patients response to aspirin. Thus previous studies have estimated that 5% to 60% of the population do not achieve an adequate anti-platelet effect from aspirin.
It is based on these observations that the concepts "clinical aspirin resistance" and "biochemical aspirin resistance" have been generated. Our study is the first to demonstrate an association between biochemical aspirin resistance and clinical aspirin resistance in the setting of an acute myocardial infarction. However, we have not shown that the myocardial infarction was caused by the absent response to aspirin.
Future studies addressing the phenomenon "aspirin resistance" are required. These studies should aim to clarify:
1) If aspirin resistance is a new independent predictor of cardiovascular events
2) Why some patients do not have the expected effect of aspirin
3)Whether these patients will benefit from alternative anti-platelet therapy
The study was funded by grants from The Danish Heart Foundation, private Danish funds (Fonden for L'¦gevidenskabelig Forskning ved Fyns Amts Sygehusv'¦sen, Overl'¦ger'ådets Legatudvalg ved Odense Universitetshospital, Fyns Amts Forskningspulje 2002, T'¸mrermester Alfred Andersens og Hustru's Fond, Klinisk Institut, Syddansk Universitet) and from Bristol-Myers Squibb, Dade Behring and Pfizer ApS.
Tina Poulsen, MD, Ph.D. student
Odense University Hospital,
Denmark
European Society of Cardiology (ESC)
The study was carried out at Odense University Hospital from 8th May 2002 to 23rd May 2003. We examined all patients admitted on suspicion of an acute myocardial infarction, and who prior to admission were on routine treatment with aspirin 150 mg daily. Immediately on hospital admission blood samples were taken from the 298 patients included in order to measure the platelet inhibiting effect of aspirin.
Despite being on treatment with aspirin almost one fourth of the patients experienced an acute myocardial infarction. Among the patients with acute myocardial infarction, we could not measure the expected effect of aspirin in 36%. In patients without acute myocardial infarction, a significantly smaller, but still considerable proportion (19%) also demonstrated an absent effect of aspirin.
The prognostic benefit of aspirin has been documented in several prior studies. However, over a two-year period one in ten patients will suffer a cardiovascular event despite daily aspirin therapy. In addition laboratory studies examining the platelet inhibiting effect of aspirin have shown a wide variability in patients response to aspirin. Thus previous studies have estimated that 5% to 60% of the population do not achieve an adequate anti-platelet effect from aspirin.
It is based on these observations that the concepts "clinical aspirin resistance" and "biochemical aspirin resistance" have been generated. Our study is the first to demonstrate an association between biochemical aspirin resistance and clinical aspirin resistance in the setting of an acute myocardial infarction. However, we have not shown that the myocardial infarction was caused by the absent response to aspirin.
Future studies addressing the phenomenon "aspirin resistance" are required. These studies should aim to clarify:
1) If aspirin resistance is a new independent predictor of cardiovascular events
2) Why some patients do not have the expected effect of aspirin
3)Whether these patients will benefit from alternative anti-platelet therapy
The study was funded by grants from The Danish Heart Foundation, private Danish funds (Fonden for L'¦gevidenskabelig Forskning ved Fyns Amts Sygehusv'¦sen, Overl'¦ger'ådets Legatudvalg ved Odense Universitetshospital, Fyns Amts Forskningspulje 2002, T'¸mrermester Alfred Andersens og Hustru's Fond, Klinisk Institut, Syddansk Universitet) and from Bristol-Myers Squibb, Dade Behring and Pfizer ApS.
Tina Poulsen, MD, Ph.D. student
Odense University Hospital,
Denmark
European Society of Cardiology (ESC)
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