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The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients

An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study

From the Sinai Center for Thrombosis Research, Baltimore, Maryland

Address correspondence and reprint requests to Paul A. Gurbel, MD, Sinai Center for Thrombosis Research, Hoffberger Building, Suite 56, 2401 W. Belvedere Ave., Baltimore, MD 21215. E-mail: pgurbel{at}lifebridgehealth.org

Abbreviations: 11-dh-TxB₂, 11-dehydro-thromboxane B₂; ACS, acute coronary syndrome; ARU, aspirin reaction unit; CAD, coronary artery disease; ELISA, enzyme-linked immunosorbent assay; LTA, light transmittance aggregometry; PFA, platelet function analyzer; PPP, platelet-poor plasma; PRP, platelet-rich plasma

OBJECTIVE— Diabetic patients may have a higher prevalence of platelet aspirin resistance than nondiabetic patients. Our goal was to analyze platelet aspirin responsiveness to various aspirin doses in diabetic and nondiabetic patients.

RESEARCH DESIGN AND METHODS— We examined the effect of aspirin (81, 162, and 325 mg/day for 4 weeks each) on platelet aspirin responsiveness in 120 stable outpatients (30 diabetic patients and 90 nondiabetic patients) with coronary artery disease (CAD) using light transmittance aggregometry (LTA), VerifyNow, platelet function analyzer (PFA)-100, and levels of urinary 11-dehydro-thromboxane B₂ (11-dh-TxB₂).

RESULTS— In the total group, a low prevalence (0–2%) of aspirin resistance was observed with all aspirin doses as determined by arachidonic acid–induced LTA. Aspirin resistance was higher at the 81-mg dose in diabetic versus nondiabetic patients using collagen-induced LTA (27 vs. 4%, P = 0.001), VerifyNow (13 vs. 3%, P = 0.05), and urinary 11-dh-TxB₂ (37 vs. 17%, P = 0.03). Diabetic patients treated with 81 mg exhibited higher platelet function measured by VerifyNow, collagen- and ADP-induced LTA, and 11-dh-TxB₂ levels (P 0.02 for all comparisons). Higher aspirin doses significantly inhibited platelet function and decreased aspirin resistance in diabetic patients (P < 0.05).

CONCLUSIONS— Diabetic patients with CAD treated with 81 mg aspirin exhibit a higher prevalence of aspirin resistance and have significantly higher ADP- and collagen-induced platelet aggregation, 11-dh-TxB₂ levels, and aspirin reaction units measured by VerifyNow than nondiabetic patients. Increased aspirin dosing resulted in similar rates of resistance and platelet function levels between groups. These findings indicate that diabetic patients exhibit a global high platelet reactivity phenotype that may be partially overcome by higher aspirin doses.

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				P.-S. Klein Comment on: DiChiara et al. (2007) The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients: An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study: Diabetes 56:3014-3019, 2007 Diabetes, May 1, 2008; 57(5): e10 - e10. [Full Text] [PDF]

				J. DiChiara, K. P. Bliden, U. S. Tantry, M. S. Hamed, M. J. Antonino, T. A. Suarez, O. Bailon, A. Singla, and P. A. Gurbel Response to Comment on: DiChiara et al. (2007) The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients: An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study: Diabetes 56:3014-3019, 2007 Diabetes, May 1, 2008; 57(5): e11 - e11. [Full Text] [PDF]