Stroke and aspirin non-responder patients: relation with hypertension and platelet response to adenosine diphosphate

Platelets. 2009 Nov;20(7):471-7. doi: 10.3109/09537100903171404.

Abstract

Despite its widespread use, there are many concerns about the efficacy of aspirin in the secondary prevention of cardiovascular events after stroke, leading to the concept of aspirin non-response (ANR). Although the mechanisms of ANR remain uncertain, it is expected to be due to a combination of clinical, biological and genetic characteristics affecting platelet function. In this study, we investigated whether clinical and/or biological factors such as hypertension and platelet response to ADP could contribute to the ANR. As a secondary objective, we determine whether ANR and collagen/ADP closure time (CADP-CT) could be related to platelet glycoprotein single nucleotide polymorphisms (SNPs). One hundred patients on aspirin (160 mg/day) were enrolled. ANR was measured with a platelet function analyzer (PFA-100); genotyping of four SNPs (GP IIIa, GP Ia, P2Y12 and GP VI) was performed using a tetra-primer amplification refractory mutation system. Using a collagen/epinephrine-coated cartridge on the PFA-100, the prevalence of ANR was 15% (n = 15). In the ANR group, (i) CADP-CT was significantly shorter and (ii) hypertension was an independent clinical predictive factor of ANR (OR = 4.25; 95%CI: 1.06-17.11). No clear relation was found between CADT-CT and platelet gene polymorphism as well as ANR status and SNPs. In conclusion our study confirms the independent relationship between hypertension, platelet hypersensitivity to ADP and aspirin (160 mg/day) non-response. The differential sensitivity to aspirin may have potential clinical implications, where adaptation of antiplatelet therapy is necessary according to a patient's clinical and genetic characteristics.

Publication types

  • Clinical Trial

MeSH terms

  • Adenosine Diphosphate / therapeutic use*
  • Aged
  • Aspirin / therapeutic use*
  • Blood Platelets / physiology
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / genetics
  • Hypertension / prevention & control*
  • Male
  • Middle Aged
  • Platelet Aggregation / drug effects
  • Platelet Aggregation / genetics
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Polymorphism, Genetic
  • Polymorphism, Single Nucleotide
  • Prospective Studies
  • Stroke / blood
  • Stroke / drug therapy*
  • Stroke / genetics
  • Stroke / prevention & control

Substances

  • Platelet Aggregation Inhibitors
  • Adenosine Diphosphate
  • Aspirin