Aspirin resistance: Fact or fiction? A point of view

Table 3 Underlying causes of “aspirin resistance”

Abnormal pharmacokinetics

Non-compliance

Inadequate dosing

Tachyphylaxis

Interaction with other drugs, such as NSAIDs and PPIs

Clinical conditions

Advanced coronary artery disease, acute coronary syndromes, CABG

Diabetes mellitus

Heart failure

Infection/inflammation

Obesity

Genetic

COX-1 gene mutation

COX-2 overexpression

GpIIb-IIIa polymorphisms

Molecular

Increased turnover of platelets

PGH2 substrate is provided to platelets by monocytes or endothelial cells

Incomplete inhibition of TXA2 formation

Increased platelet sensitivity to ADP and collagen

Increased COX-2 expression on platelets

COX: Cyclooxygenase; NSAIDs: Non-steroidal anti-inflammatory drugs; PPIs: Proton pump inhibitors; Gp: Glycoprotein; TXA₂: Thromboxane A₂; PGH₂: Prostaglandin H₂; ADP: Adenosine diphosphate.