Aspirin Resistance: Risk Factors and Prognostic Significance in Patients with Cerebral Small Vessel Disease.

BACKGROUND

The clinical significance of aspirin resistance (AR) in patients with symptomatic cerebrovascular disease is not well known. The aim of this single-center, prospective study was to examine the prevalence, risk factors and prognostic significance of AR in patients with different clinical manifestations of cerebral small vessel disease (CSVD) over 24-month follow-up.

METHODS

We studied 104 patients with MRI confirmed CSVD, including those with recent lacunar stroke (LS, n=49), vascular parkinsonism (VaP, n=16) and dementia (VaD, n=39). Platelet aggregation was evaluated with electrode platelet aggregometry (Multiplate analyzer); AR was defined as a value of ≥300 AUC*min. All patients had 24-h ABPM performed at baseline. Radiological progression was recognized based on repeated MRI examinations.

RESULTS

The prevalence of AR was 26%, and it did not differ between LS, VaD, and VaP (22.4%, 28.2%, and 31.3%, respectively; p=0.7). The patients with AR had higher triglyceride levels (TG; 144.2±100 vs 109.7±48 mg/dl; p=0.09) and mean arterial blood pressure (MAP; 103.5±15.2 vs 91.7±10.5 mmHg; p<0.01) than did responders to aspirin (RTA). TG (OR 1.02; 95%CI 1-1.11; p=0.04) and MAP (OR 1.03; 95%CI 1.0-1.09; p=0.04) were independent of age, sex, statin and antihypertensive treatment risk factors for AR. The patients with AR more frequently experienced ischemic strokes than did those with RTA (OR 3.1; 98%CI 1.08-9.3; p=0.03) and had more radiological progression (OR 2.2; 95%CI 0.9-5.7; p=0.08). AR was independent of age, sex, baseline Fazekas score predictor of lacunar stroke (OR 3.79; 95%CI 1.19-12; p=0.02) and radiological progression (OR 2.9; 95%CI 1.04-8.3; p=0.04).

CONCLUSIONS

The prevalence of AR was high and similar among the patients with LS, VaD, and VaP due to CSVD. Higher 24-h MAP and TG were independently related to the risk of AR. AR was associated with risk of radiological progression and lacunar strokes over 24 months of observation.