Yale: Acute Coronary Syndrome: Importance of Prior Aspirin Therapy

CONTENTS

Yale University
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Yale

Importance of Prior Aspirin Therapy in Patients Presenting With Acute Coronary Syndrome

Patients presenting with an acute coronary syndrome despite prior aspirin therapy are at high risk for subsequent cardiac events. This risk can be attenuated using GPIIb/IIIa inhibitor treatment.

The relationship between prior aspirin therapy and the effect of eptifibatide was examined in the PURSUIT study [1]. Among the 10,948 patients in the trial, nearly two-thirds were on aspirin therapy prior to presenting with an acute coronary syndrome. A 25% higher event rate (death or MI at 30 days) was noted in the placebo arm in patients who were on prior aspirin therapy (17.3%) relative to patients not taking aspirin prior to presentation (12.9%). This risk was attenuated with GPIIb/IIIa treatment [2] (Table 1).

Thus, patients presenting with a non-ST-segment elevation acute coronary syndrome despite prior aspirin use reflect a high-risk population. This group of patients should be managed aggressively, including GPIIb/IIIa therapy. The effects of GPIIb/IIIa inhibition are potentiated by prior aspirin use. In addition, their use attenuates the risk seen in “aspirin failure” patients.

Fig. 1. Importance of prior aspirin therapy in patients presenting with acute coronary syndrome.

Fig. 1

Alexander JH, et al. J Am Coll Cardiol. 1998; 31 (Suppl A); 93A.

1. The PURSUIT Trial Investigators. Inhibition of Platelet Glycoprotein IIb/IIIa with Eptifibatide in Patients With Acute Coronary Syndrome. N Engl J Med. 1998; 339: 436-443.

2. Alexander JH, Harrington RA, Guerci A, et al. Prior Aspirin use Potentiates the Effect of GP IIb/IIIa inhibition in Patients with Non-ST Elevation Acute Coronary Syndrome. J Am Coll Cardiol. 1998; 31(Suppl A): 93A.