A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease

Aims We sought to compare the results obtained from six major platelet function tests in the assessment of the prevalence of aspirin resistance in patients with stable coronary artery disease. Methods and results 201 patients with stable coronary artery disease receiving daily aspirin therapy (≥80 mg) were recruited. Platelet aggregation was measured by: (i) light transmission aggregometry (LTA) after stimulation with 1.6 mM of arachidonic acid (AA), (ii) LTA after adenosine diphosphate (ADP) (5, 10, and 20 µM) stimulation, (iii) whole blood aggregometry, (iv) PFA-100®, (v) VerifyNow Aspirin®; urinary 11-dehydro-thromboxane B2 concentrations were also measured. Eight patients (4%, 95% CI 0.01-0.07) were deemed resistant to aspirin by LTA and AA. The prevalence of aspirin resistance varied according to the assay used: 10.3-51.7% for LTA using ADP as the agonist, 18.0% for whole blood aggregometry, 59.5% for PFA-100®, 6.7% for VerifyNow Aspirin®, and finally, 22.9% by measuring urinary 11-dehydro-thromboxane B2 concentrations. Results from these tests showed poor correlation and agreement between themselves. Conclusion Platelet function tests are not equally effective in measuring aspirin's antiplatelet effect and correlate poorly amongst themselves. The clinical usefulness of the different assays to classify correctly patients as aspirin resistant remains undetermined.