Results indicated that some PFTs may have some prognostic utility , i.e. a trend for more clinical events to be associated with groups classified as ' aspirin resistant ' .
Study -level effect sizes were generally small and absolute outcome risk was not substantially different between ' aspirin resistant ' and ' aspirin sensitive ' design ations .
Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification , the economic model found that a test-treat strategy was likely to be cost-effective .
However , neither assumption is currently evidence based .
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease .
However , a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment .
It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity .
This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ( ' aspirin resistance ' ) , as defined using platelet function tests ( PFTs ) , is linked to the occurrence of adverse clinical outcomes , and further , whether or not patients at risk of future adverse clinical events can be identified through PFTs .
OBJECTIVES To review systematic ally the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT design ation of ' aspirin resistance ' and the risk of adverse clinical outcome ( s ) in patients prescribed aspirin therapy .
To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs .
Prospective evaluation of the relationship between platelet–leukocyte conjugate formation and recurrent myocardial ischemia in patients with acute coronary syndromes
Platelet – leukocyte conjugates are increased in patients with coronary artery disease but the relationship between conjugate formation and myocardial ischemic outcome is unknown . We prospect ively evaluated the relationship between conjugate formation and the development of recurrent myocardial ischemia in patients with acute coronary syndromes ( ACS ) . Platelet – leukocyte conjugate formation ( induced by thrombin receptor activating peptide ( TRAP ) ) and platelet aggregation ( induced by ADP and arachidonic acid ) were assessed in 30 patients with unstable angina or non-ST elevation myocardial infa rct ion . All patients were treated with β-blockers , aspirin , heparin , and GPIIb – IIIa antagonists and were followed for in-hospital recurrent myocardial ischemia . Troponin I and C-reactive protein ( CRP ) were also measured . Seven patients ( 23 % ) experienced recurrent ischemia . Platelet – neutrophil conjugates were greater in ischemic patients ( 59 ± 9 and 36 ± 4 % , P = 0.007 , for + ischemia and −ischemia , respectively ) . Platelet aggregation did not differ between ischemic and nonischemic patients , and there was no significant relationship between aspirin resistance and ischemic outcome . Troponin I was greater in patients who developed recurrent ischemia ( 3.04 ± 1.73 vs. 0.70 ± 0.21 ng/ml , P = 0.03 , for + ischemia and −ischemia , respectively ) but CRP was not . TRAP-induced platelet – neutrophil conjugate formation was an independent predictor of ischemic outcome ( OR 1.07 , 95 % CI 1.00–1.15 , for each 1 % increase in conjugate formation ) . Receiver operator characteristic analysis showed platelet – neutrophil conjugates to have good ability to discriminate between ischemic and nonischemic patients ( AUC of 0.84 , P<0.05 ) . TRAP induced platelet – neutrophil conjugate formation is related to in vivo ischemic risk in ACS patients
Results indicated that some PFTs may have some prognostic utility , i.e. a trend for more clinical events to be associated with groups classified as ' aspirin resistant ' .
Study -level effect sizes were generally small and absolute outcome risk was not substantially different between ' aspirin resistant ' and ' aspirin sensitive ' design ations .
Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification , the economic model found that a test-treat strategy was likely to be cost-effective .
However , neither assumption is currently evidence based .
BACKGROUND The use of aspirin is well established for secondary prevention of cardiovascular disease .
However , a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment .
It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity .
This report aims to investigate whether or not insufficient platelet function inhibition by aspirin ( ' aspirin resistance ' ) , as defined using platelet function tests ( PFTs ) , is linked to the occurrence of adverse clinical outcomes , and further , whether or not patients at risk of future adverse clinical events can be identified through PFTs .
OBJECTIVES To review systematic ally the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT design ation of ' aspirin resistance ' and the risk of adverse clinical outcome ( s ) in patients prescribed aspirin therapy .
To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs .