Biological efficacy of twice daily aspirin in type 2 diabetic patients with coronary artery disease

Background Diabetes is associated with a high rate of events after acute coronary syndrome and percutaneous coronary intervention despite aspirin treatment. Once daily aspirin might not provide 24-hour stable biological efficacy in patients with diabetes. We compared the biological efficacy of the s...

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Published in:The American heart journal 2012-10, Vol.164 (4), p.600-606.e1
Main Authors: Dillinger, Jean-Guillaume, MD, Drissa, Akram, MD, Sideris, Georgios, MD, Bal dit Sollier, Claire, PhD, Voicu, Sebastian, MD, Manzo Silberman, Stephane, MD, Logeart, Damien, MD, Drouet, Ludovic, MD, PhD, Henry, Patrick, MD, PhD
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Analysis of Variance
Arachidonic Acid - administration & dosage
Aspirin
Aspirin - administration & dosage
Biological and medical sciences
Blood platelets
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Coronary Artery Disease - blood
Coronary Artery Disease - complications
Coronary heart disease
Coronary vessels
Cross-Over Studies
Diabetes
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - complications
Diabetes. Impaired glucose tolerance
Diabetic Angiopathies - blood
Drug Administration Schedule
Drug Resistance - physiology
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Female
Heart
Heart attacks
Humans
Male
Medical sciences
Middle Aged
Platelet Activation - drug effects
Platelet Activation - physiology
Platelet Aggregation - drug effects
Platelet Aggregation Inhibitors - administration & dosage
Population
Prospective Studies
Statistical analysis
Ticlopidine - administration & dosage
Ticlopidine - analogs & derivatives
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Summary:Background Diabetes is associated with a high rate of events after acute coronary syndrome and percutaneous coronary intervention despite aspirin treatment. Once daily aspirin might not provide 24-hour stable biological efficacy in patients with diabetes. We compared the biological efficacy of the same daily dose of aspirin given either once (OPD) or divided twice per day in a population of diabetic patients with previous coronary artery disease. Methods Ninety-two consecutive diabetic patients with at least 1 criteria of time-dependent aspirin efficacy, elevated high-sensibility C-reactive protein (hs-CRP), fibrinogen, platelet count, or active smoking were prospectively included. Consecutive patients were randomly treated with 150-mg aspirin daily given either OPD (150 mg in the morning) or twice per day (75 mg in the morning and 75 mg in the evening) in a crossover study. The main outcome was platelet reactivity to arachidonic acid (0.5 mg/mL) measured by light transmission aggregometry at trough level before morning aspirin intake. Results Mean maximum aggregation intensity triggered by arachidonic acid was 19.7% ± 15.4% on OPD and 11.9% ± 10.4% on twice per day ( P < .0001). Biological resistance (maximum aggregation intensity ≥20%) was observed in 42% of patients on OPD and 17% on twice per day ( P < .001). Of the 39 patients with biological resistance on OPD, 24 (62%) overcame resistance on twice per day. Of the 16 resistant on twice per day, only 1 patient (6%) overcame resistance on OPD. Results were concordant with global evaluation of platelet reactivity by Platelet Function Analyzer-100. A better twice per day efficacy was independent of clopidogrel cotreatment. Conclusion In a population of diabetic patients with coronary artery disease and a high risk of time-dependent aspirin resistance, aspirin divided twice per day can significantly decrease the rate of biological loss of efficacy at trough level.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2012.06.008