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

Abstract

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.

• Authors: Jean-Guillaume Dillinger, Akram Drissa, Georgios Sideris, Claire Bal dit Sollier, Sebastian Voicu, Stephane Manzo Silberman, Damien Logeart, Ludovic Drouet, Patrick Henry
• Journal: American heart journal (Am Heart J) Vol. 164 Issue 4 Pg. 600-606.e1 (Oct 2012) ISSN: 1097-6744 [Electronic] United States
• PMID: 23067920 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2012 Mosby, Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Arachidonic Acid
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Analysis of Variance
• Arachidonic Acid (administration & dosage)
• Aspirin (administration & dosage)
• Clopidogrel
• Coronary Artery Disease (blood, complications)
• Cross-Over Studies
• Diabetes Mellitus, Type 2 (blood, complications)
• Diabetic Angiopathies (blood)
• Drug Administration Schedule
• Drug Resistance (physiology)
• Female
• Humans
• Male
• Middle Aged
• Platelet Activation (drug effects, physiology)
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (administration & dosage)
• Prospective Studies
• Ticlopidine (administration & dosage, analogs & derivatives)