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Antiplatelet effect of aspirin in patients with cerebrovascular disease.

To the Editor:

The intriguing study by Alberts et al1 regarding aspirin resistance in 129 patients with cerebrovascular disease highlights the potentially important implications of interpatient variability in response to set doses of antiplatelet agents, but also raises several important issues regarding the extrapolation of ex vivo results to clinical care. Their study focused on the level of antiplatelet activity of aspirin as measured by the platelet function analyzer (PFA)-100 point of care test. Using this device and a unique but unvalidated cut-off for dichotomizing patients into aspirin responders and nonresponders, they found that significantly more patients had inadequate platelet inhibition when receiving ≤162 mg of aspirin/d, compared with those taking ≥325 mg aspirin/d (56% versus 28%, P <0.01). They also found that patients taking enteric-coated aspirin were less likely to achieve adequate platelet inhibition compared with those taking an uncoated preparation. Although the study was too small, and follow-up too …