The role of aspirin in cardiovascular prevention: implications of aspirin resistance

J Am Coll Cardiol. 2008 May 13;51(19):1829-43. doi: 10.1016/j.jacc.2007.11.080.


Aspirin is well recognized as an effective antiplatelet drug for secondary prevention in subjects at high risk of cardiovascular events. However, most patients receiving long-term aspirin therapy still remain at substantial risk of thrombotic events due to insufficient inhibition of platelets, specifically via the thromboxane A2 pathway. Although the exact prevalence is unknown, estimates suggest that between 5.5% and 60% of patients using this drug may exhibit a degree of "aspirin resistance," depending upon the definition used and parameters measured. To date, only a limited number of clinical studies have convincingly investigated the importance of aspirin resistance. Of these, few are of a sufficient scale, well designed, and prospective, with aspirin used at standard doses. Also, most studies do not sufficiently address the issue of noncompliance to aspirin as a frequent, yet easily preventable cause of resistance to this antiplatelet drug. This review article provides a comprehensive overview of aspirin resistance, discussing its definition, prevalence, diagnosis, and therapeutic approaches. Moreover, the clinical implications of aspirin resistance are explored in various cardiovascular disease states, including diabetes mellitus, hypertension, heart failure, and other similar disorders where platelet reactivity is enhanced.

Publication types

  • Review

MeSH terms

  • Aspirin / pharmacology
  • Aspirin / therapeutic use*
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / physiopathology*
  • Diabetes Mellitus / physiopathology
  • Drug Resistance / drug effects*
  • Heart Failure / physiopathology
  • Humans
  • Hypertension / physiopathology
  • Platelet Activation / drug effects
  • Platelet Aggregation Inhibitors / pharmacology
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Rheumatic Diseases / physiopathology


  • Platelet Aggregation Inhibitors
  • Aspirin