Aggregometry in Secondary Prevention of Stroke. Aspirin Resistance

Authors: M. Fauknerová 1;  P. Osmančík 2;  M. Špaček 3;  L. Kejst 3;  P. Kalvach 1
Authors‘ workplace: FN Královské Vinohrady, Praha Neurologická klinika 3. LF UK 1;  FN Královské Vinohrady, Praha Kardiologická klinika 3. LF UK 2;  FN Královské Vinohrady, Praha Oddělení klinické hematologie 3
Published in: Cesk Slov Neurol N 2011; 74/107(5): 527-532
Category: Review Article


This paper reviews the principles of thrombocytic aggregation, available methods of measuring it and pitfalls in the interpretation of results obtained. A list of eight aggregometric methods provides descriptions of the evaluation of bleeding times, of optic and impedance whole blood aggregometry, of thrombelastography and flow cytometry, as well as describing measurements of urine levels of the metabolite thromboxan. We report how results depend on the way in which the aggregation is induced. Absolute aggregation remains, as yet, immeasurable. The effectiveness of prevention of atherosclerotic complications using anti-aggregation therapy is usually determined on the basis of studies that observe the impact of reduced thrombogenesis and emboligenesis on clinical outcome. Modifications in drug dosage are usually stipulated by such secondary and derived data. The intensity of aggregation readiness itself – due to difficulties in assessing it – plays only a minor role in these decisions and is only slowly achieving credibility. We also summarize current views on resistance to acetylsalicylic acid, which appears in two variants: clinical resistance and laboratory resistance. We conclude with an overview of future possibilities for monitoring aggregation.

Key words:
aggregometry – methods of measurement – aspirin – acetylsalicylic acid – resistance – stroke prevention – ischaemic stroke – thrombogenesis


1. Patrono C, Baigent C, Hirsh J, Roth G. American College of Chest Physicians. Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl 6): 199S–233S.

2. Bauer J. Antikoagulační terapie v prevenci a léčbě ischemických iktů. Cesk Slov Neurol N 2010; 73/106(5): 480–491.

3. Travníčková E. Fyziologie krve. In: Trojan S (ed). Lékařská fyziologie. 2. přepracované a rozšířené vydání. Praha: Grada Publishing 1996: 73–106.

4. Harrison P, Frelinger AL 3rd, Furman MI, Michelson AD. Measuring antiplatelet drug effects in the laboratory. Thromb Res 2007; 120(3): 323–336.

5. Pamukcu B. A review of aspirin resistance; definition, possible mechanisms, detection with platelet function tests, and its clinical outcomes. J Thromb Thrombolysis 2007; 23(3): 213–222.

6. Tousoulis D, Siasos G, Stefanadis C. Aspirin resistance: what the cardiologist needs to know? Int J Cardiol 2009; 132(2): 153–156.

7. Harrison P. Platelet function analysis. Blood Rev 2005; 19(2): 111–123.

8. Haubelt H, Anders C, Hellstern P. Can platelet function tests predict the clinical efficacy of aspirin? Semin Thromb Hemost 2005; 31(4): 404–410.

9. Michelson AD. Methods for the measurement of platelet function. Am J Cardiol 2009; 103 (Suppl 3): 20A–26A.

10. Smith JW, Steinhubl SR, Lincoff AM, Coleman JC, Lee TT, Hillman RS et al. Rapid platelet-function assay: an automated and quantitative cartridge-based method. Circulation 1999; 99(5): 620–625.

11. Price JM. Accumetrics VerifyNow system. User manual. USA: Accumetrics Inc 2006; 1–122.

12. Gurbel PA, Bliden KP, DiChiara J, Newcomer J, Weng W, Neerchal NK et al. Evaluation of dose-related effects of aspirin on platelet function: results from Aspirin-Induced Platelet Effect (ASPECT) study. Circulation 2007; 115(25): 3156–3164.

13. Fauknerová M, Petr R, Doležil D, Kalvach P. Stanovení agregace při různých dávkách a schématech podávání kyseliny acetylsalicylové. Cesk Slov Neurol N 2010; 73/106 (Suppl 2): S118.

14. Kuliczkowski W, Witkowski A, Polonski L, Watala C, Filipiak K, Budaj A et al. Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J 2009; 30(4): 426–435.

15. Gasparyan AY, Watson T, Lip GY. The role of aspirin in cardiovascular prevention: implications of aspirin resistance. J Am Coll Cardiol 2008; 51(19): 1829–1843.

16. Sztriha LK, Sas K, Vecsei L. Aspirin resistance in stroke: 2004. J Neurol Sci 2005; 229–230: 163–169.

17. Biller J. Aspirin nonresponse in patients with arterial causes of ischemic stroke: considerations in detection and management. J Neurol Sci 2008; 272(1–2): 1–7.

18. Kawasaki T, Ozeki Y, Igawa T, Kambayashi J. Increased platelet sensitivity to collagen in individuals resistant to low-dose aspirin. Stroke 2000; 31(3): 591–595.

19. Macchi L, Sorel N, Christiaens L. Aspirin resistance: definitions, mechanisms, prevalence, and clinical significance. Curr Pharm Des 2006; 12(2): 251–258.

20. Eikelboom JW, Hankey GJ, Thom J, Claxton A, Yi Q, Gilmore G et al. Enhanced antiplatelet effect of clopidogrel in patients whose platelets are least inhibited by aspirin: a randomized crossover trial. J Thromb Haemost 2005; 3(12): 2649–2655.

21. Dropinski J, Jakiela B, Sanak M, Wegrzyn W, Biernat M, Dziedzina S et al. The additive antiplatelet action of clopidogrel in patients with coronary artery disease treated with aspirin. Thromb Haemost 2007; 98(1): 201–209.

22. Grotemeyer KH, Scharafinski HW, Husstedt IW. Two-year follow–up of aspirin responder and aspirin non responder. A pilot-study including 180 post-stroke patients. Thromb Res 1993; 71(5): 397–403.

23. Eikelboom JW, Hirsh J, Weitz JI, Johnston M, Yi Q, Yusuf S. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardio­vascular death in patients at high risk for cardiovascular events. Circulation 2002; 105(14): 1650–1655.

24. Gum PA, Kottke-Marchant K, Welsh PA, White J, Topol EJ. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 2003; 41(6): 961–965.

25. Grundmann K, Jaschonek K, Kleine B, Dichgans J, Topka H. Aspirin non-responder status in patients with recurrent cerebral ischemic attacks. J Neurol 2003; 250(1): 63–66.

26. Mehta JL, Mohandas B. Aspirin resistance: fact or fiction? A point of view. World J Cardiol 2010; 2(9): 280–288.

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