Article information
Abstract
Objectives
The purpose of this study is to review the prevalence of aspirin resistance in patients with a high risk of cardiovascular events, and secondly, to investigate its epidemiology and mechanism of action, and the clinical consequences it can provoke.
Material and methodsA search was run on PubMed, EMBASE and Reviews Database for English or Spanish articles on aspirin resistance published up to November 2008. Additional studies were obtained by searching the reference lists in the selected articles for articles relevant to our secondary objectives.
ResultsAspirin resistance is described as affecting 0% to 57% of the population, and is related to a decreased protective effect against strokes and cardiovascular events. Many modifiable and unmodifiable factors can affect the efficacy of antiplatelet drugs. Possible strategies for overcoming this decreased antiaggregant effect include increasing the aspirin dosage or dual therapy with another antiplatelet agent.
ConclusionsLack of response to aspirin decreases its protective effects. However, lack of a standard definition for aspirin resistance, the absence of diagnostic reference methods to identify resistant patients, and the different mechanisms of action involved in platelet aggregation call the clinical importance of this fact into question. Additional well-designed studies are needed to detect patients with real resistance in order to have more effective prevention of cardiovascular morbidity and mortality.
Keywords:
Acetylsalicylic acid
Drug resistance
Epidemiology
Mechanism of action
Risk factors
Cardiovascular disease
Review
Resumen
Objetivo
Revisar la prevalencia de resistencia a la aspirina en pacientes de alto riesgo cardiovascular y, de forma secundaria, investigar la epidemiología, los mecanismos de acción de este fenómeno y las consecuencias clínicas que se derivan de ello.
Material y métodosSe realizó una búsqueda en PubMed, EMBASE y Reviews Database de artículos publicados en inglés y en español hasta noviembre de 2008 referidos a resistencia a la aspirina. Se hizo también un seguimiento de las referencias para recuperar aquellas consideradas relevantes para los objetivos secundarios de esta revisión.
ResultadosLa resistencia a la aspirina se describe entre un 0 y un 57%, lo que se traduce en una disminución de la eficacia protectora frente a eventos cerebrovasculares y cardiovasculares. Numerosos factores modificables, así como otros no modificables, influyen en la eficacia del efecto antiagregante. Las estrategias por seguir para contrarrestar esta antiagregación disminuida pueden dirigirse a un aumento de dosis de aspirina o a la terapia dual junto con otros agentes antiplaquetarios.
ConclusionesLa falta de respuesta a la aspirina disminuye su eficacia protectora. Sin embargo, la falta de una definición de resistencia a la aspirina universalmente consensuada y la inexistencia de un método diagnóstico de referencia que identifique con fiabilidad a pacientes resistentes, así como los diferentes mecanismos de acción implicados en la agregación plaquetaria, cuestionan la relevancia clínica de este fenómeno. Son necesarios más estudios clínicos adecuadamente diseñados para detectar pacientes con verdadera resistencia a la aspirina y así conseguir prevenir de manera más eficaz la morbimortalidad cardiovascular.
Palabras clave:
Ácido acetilsalicílico
Resistencia a fármacos
Epidemiología
Mecanismo de acción
Factores de riesgo
Enfermedad cardiovascular
Revisión
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