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Lack of subjective tendency to bleed as clinical marker for aspirin resistance

The anti-platelet effect of aspirin (ASA) is widely proven to be effective in the prevention of fatal and non-fatal cardiovascular events in high risk patients. However, despite being on aspirin therapy, 10–20% of patients experience recurrent vascular events over a long period of time, thus the term ASA treatment failure. On the other hand, ASA resistance is commonly used to define the failure of aspirin to inhibit the thromboxane A2 production or the platelet aggregation at the laboratory level. The direct correlation between the laboratory and the clinical aspirin resistance has been shown previously. The demographic and the clinical markers of bleeding (through questionnaire) were collected in 114 patients on routine ASA treatment for cardiovascular events. The rapid platelets functional assay for aspirin was measured. The proportion, Fisher’s exact test, Spearman rho correlation, and cyclooxygenase-proportional univariate analysis were used. The statistical significance value was considered for p< 0.05. Out of 134 eligible patient, 114 (85%) agreed to participate in this study. ASA resistant was found in 13.8% in male as compared to 4.7% in female with p1⁄4 0.04. There was no significant correlation between ASA resistance and age, race, absence of mucocutaneous bleeding, smoking, diabetes, hypertension, kidney diseases, and other comorbidities. There is no clinical correlation to ASA resistance. However, ASA resistance is seen more with male gender. Further prospective studies to validate such correlation should be designed to eliminate the compliance confounder factor. The anti-platelet effect of aspirin is widely proven to be effective in the prevention of fatal and non-fatal cardiovascular events in high risk patients [1]. Aspirin (ASA) reduces the activation of platelets by irreversibly acetylating cyclooxygenase-1 [2–6]. However, despite being on aspirin therapy, 10–20% of patients experience recurrent vascular events over a long period of time [7]. Thus, the term ‘‘aspirin treatment failure’’ has been used to describe the occurrence of any atherothromboembolic ischemic events in compliant patients [8, 9]. On the other hand, the term ‘‘aspirin resistance’’ detected with laboratory tests is used to define the failure of aspirin to inhibit the thromboxane A2 production or the platelet aggregation and varies from 0.5% to 45% [10–12]. The direct correlation between the laboratory and the clinical aspirin resistance has been shown previously [13, 14], however, a clinical tool that predict ASA resistance is still lacking. The clinical implication of such simple tool will be of great benefit in preventing secondary cardiovascular events, since testing for aspirin resistance is expensive and not widely available. The goal of this project is to find any clinical marker that can predicts ASA resistance. Therefore, this project is designed to test the correlation between the ASA resistance testing and the absence of any mucocutaneous bleeding. To our knowledge, Clinical markers (through questionnaire) assessing for aspirin resistance has not been described yet. In an effort to find clinical markers that help in identifying aspirin resistant patients, we designed a pilot prospective cohort study. The study aim was to test aspirin resistance using rapid platelets functional assay for aspirin (RPFA-ASA) (VerifyNow aspirin by Accumetrics ) and correlate it with subjective mucocutaneous bleeding as reported by a selfdocumented questionnaire. As questionnaires are becoming an important tool in human research, we took several steps in developing a self-reporting questionnaire. Two groups involving different health care professional workers (physicians, nurses, administrative, and public health professionals) at Staten Island University Hospital and School of public health at State University of New York-Downstate, met on a weekly basis for 3 months to create and develop this questionnaire. At the end of this period, this questionnaire was presented to randomly chosen patients as a testing group. All questions,