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Laboratory Aspirin Resistance Reversibility in Diabetic Patients: a Pilot Study Using Different Pharmaceutical Formulations

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Abstract

Purpose

Aspirin resistance occurs most frequently in diabetic patients and is associated with poor prognosis. The purpose of this study was to evaluate the prevalence of aspirin resistance in a cohort of diabetic patients and whether it can be reversed using more bioavailable aspirin formulations.

Methods

Platelets function of 163 diabetic patients taking acetyl salicylic acid (ASA) 100 mg daily has been evaluated with PFA100 and VerifyNow. Patients found resistant by at least one test received an infusion of 288 mg of lysine acetylsalicylate (Flectadol®) corresponding to ASA 160 mg. Platelets function was measured again after 1 and 24 h. Patients whose the resistance was reversed received 288 mg of soluble salt of lysine acetylsalicylate (Cardirene 160®) corresponding to ASA160 mg instead of aspirin and their aggregation status was re-evaluated after 1 month of therapy.

Results

Prevalence of aspirin resistance in our population was 18,4 % (30/163). In 27 out of 30 patients (90 %) aspirin resistance was reversed within 24 h from the infusion. 25 out of 27 patients (92 %) were found fully aspirin-sensitive after 1 month of oral therapy with soluble salt; two patients were found with borderline value. No adverse reactions were observed.

Conclusions

A significant number of diabetic patients are resistant to aspirin therapy. A single intravenous dose of lysine acetylsalicylate can reverse the platelet hyper-aggregability and laboratory aspirin resistance in large majority of patients. The efficacy of antiaggregation can be maintained by chronic therapy with an oral drug with a more favourable pharmacokinetic profile.

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Abbreviations

ACEi:

angiotensin converting enzyme inhibitor

ACS:

acute coronary syndrome

ARB:

angiotensin receptor blockers

ASA:

acetyl salicylic acid

BB:

beta-blockers

CAD:

coronary artery disease

COX 1:

cyclooxygenase 1

CT:

closure time

LAS:

lysine acetylsalicylate

OH:

oral hypoglycaemic

PFA:

Platelet Function Analyzer

PPI:

proton pump inhibitor

ROS:

reactive oxygen species

SPECT:

single-photon emission computed tomography

TIA:

transient ischaemic attack

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Acknowledgment

We would like to thank Roberto Passera PhD, for his assistance during the study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy

    Roberto Grimaldi, Marta Bisi, Enrica Lonni, Marco Francesco Lococo, Davide Giacomo Presutti & Fiorenzo Gaita

  2. Division of Haematology and Oncology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy

    Eloise Beggiato, Alessandra Valpreda & Enrico Dosio

  3. Division of Endocrinology,Diabetology and Metabolism, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy

    Milena Tagliabue

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  1. Roberto Grimaldi
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  2. Marta Bisi
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Correspondence to Marta Bisi.

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Grimaldi, R., Bisi, M., Lonni, E. et al. Laboratory Aspirin Resistance Reversibility in Diabetic Patients: a Pilot Study Using Different Pharmaceutical Formulations. Cardiovasc Drugs Ther 28, 323–329 (2014). https://doi.org/10.1007/s10557-014-6536-7

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