Identifying determinants of variability to tailor aspirin therapy

Bianca Rocca, Francesca Pagliaccia, Alfredo Dragani

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Once-daily, low-dose aspirin is a cornerstone in the prophylaxis and treatment of cardiovascular diseases. Aspirin 'resistance' still lacks definition, a standardized reference assay, underlying mechanisms, clinical impact or efficacy of alternative antiplatelet drugs. Aspirin response in several studies has been measured by different platelet function tests, not always reflecting aspirin pharmacodynamics, thus generating significantly heterogeneous results. The EMA indicated serum thromboxane B2 as the only valid surrogate assay to study different aspirin formulations. Rather than resistance, recent studies focused on sources of intra- and inter-individual variability in response to aspirin, based on pharmacokinetic and/or pharmacodynamic mechanisms. Drug interactions, diabetes, conditions of increased platelet output, obesity and aging can potentially increase the variability of aspirin response. Preliminary studies testing different aspirin regimens showed that twice-daily low doses were more effective than once-daily higher aspirin doses on surrogate end points of platelet inhibition. Large studies are needed to test new disease-tailored, low-dose aspirin regimens.
Original languageEnglish
Pages (from-to)365-379
Number of pages15
JournalExpert Review of Cardiovascular Therapy
Volume11
DOIs
Publication statusPublished - 2013

Keywords

  • Animals
  • Aspirin
  • Blood Platelets
  • Cardiovascular Diseases
  • Dose-Response Relationship, Drug
  • Drug Interactions
  • Drug Resistance
  • Humans
  • Platelet Aggregation Inhibitors
  • Platelet Function Tests

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