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

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

  1. Joseph DiChiara,
  2. Kevin P. Bliden,
  3. Udaya S. Tantry,
  4. Miruais S. Hamed,
  5. Mark J. Antonino,
  6. Thomas A. Suarez,
  7. Oscar Bailon,
  8. Anand Singla and
  9. Paul A. Gurbel
  1. From the Sinai Center for Thrombosis Research, Baltimore, Maryland
  1. 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

Abstract

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.

Footnotes

  • Published ahead of print at http://diabetes.diabetesjournals.org on 11 September 2007. DOI: 10.2337/db07-0707.

    P.A.G. has received research funding from Hemoscope, the National Institutes of Health, Schering, Millennium, and Bayer.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted September 7, 2007.
    • Received May 24, 2007.
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  1. Published online before print September 11, 2007, doi: 10.2337/db07-0707 Diabetes December 2007 vol. 56 no. 12 3014-3019
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