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CLINICAL RESEARCH: ASPIRIN, NON-STEROIDAL ANTI-INFLAMMATORY, AND CAD

Inhibition of platelet aggregation by aspirin progressively decreases in long-term treated patients

^* Department of Experimental Medicine and Pathology, University "La Sapienza," Rome, Italy

Manuscript received May 26, 2003; revised manuscript received July 11, 2003, accepted August 5, 2003.

^* Reprint requests and correspondence: Prof. Fabio M. Pulcinelli, Dipartimento di Medicina Sperimentale e Patologia, Università degli Studi "La Sapienza," Viale Regina Elena 324, 00161 Rome, Italy.
fabio.pulcinelli{at}uniroma1.it

OBJECTIVES: We sought to investigate, during a two-year follow-up period, the effects of aspirin on platelet aggregation.

BACKGROUND: The platelets of patients given aspirin may be less sensitive to antiplatelet treatment, although the extent of such phenomenon over long-term follow-up is unclear.

METHODS: Adenosine diphosphate (ADP) and collagen-induced platelet aggregation was periodically monitored before and after 2, 6, 12, and 24 months of treatment with aspirin (n = 150) or ticlopidine (n = 80) in patients matched for gender, age, and risk factors for atherothrombosis.

RESULTS: Compared with baseline values, two months of aspirin treatment significantly inhibited platelet aggregation; thereafter, this inhibitory effect progressively decreased. At 24-month follow-up, collagen-induced platelet aggregation was significantly higher than that observed at two months (p < 0.05); a more pronounced difference was observed when collagen-induced lag phase was considered (p < 0.01). Restoration of platelet aggregation was less evident when ADP was used as an agonist. Conversely, the inhibition induced by ticlopidine was constant throughout follow-up with both agonists.

CONCLUSIONS: The study demonstrates that a long-term treatment with aspirin is associated with a progressive reduction in platelet sensitivity to this drug.

Abbreviations and Acronyms   ADP = adenosine diphosphate   COX-1 = cyclooxygenase-1   Mx% = maximal percentage   TXA2 = thromboxane A2   TXB2 = thromboxane B2

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