EDITORIAL

      87Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine

Aspirin Resistance and Its Importance

Aru W. Sudoyo
Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, 
Jakarta, Indonesia.

Correspondence mail:
Division of Haematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas 
Indonesia - Cipto Mangunkusumo Hospital. Jl. Diponegoro 71, Jakarta 10430, Indonesia. email: arusudoyo@gmail.com.

The use of salicylates (popularly known 
as aspirin or ASA) is well established for 
the secondary prevention of cardiovascular 
disease. However, there are reportedly a numer 
of patients who suffered repeat cardiovascular 
events despite being given aspirin “prophylaxis”, 
and uncertainty prevails on whether or not 
this is due to an inherent inability of aspirin to 
sufficiently modify platelet activity or are there 
other mechanisms involved. Coined as “aspirin 
resistance”, the condition warrants attention as an 
ineffective prophylaxis may lead to unexpected 
morbidity and subsequent disappointment.1

Therefore, it is important that patients 
who do not benefit from aspirin prophylaxis 
are identified. In Indonesia, a country with the 
fourth largest population in the world, with 
cerebrovascular disease as the top killer, the 
problem becomes more relevant as even a 
small percentage of the population goes a long 
way. However, several issues will have to be 
addressed: firstly, resistance (or sensitivity, for 
that matter) tests will have to take into account 
polymorphisms and ethnic characteristic – based 
on local population data; secondly, the test will 
have to be relatively simple and easy, covering 
a wide spectrum of health facilities.2

The report by Kurniawan, et al.3, a cross-
sectional study with the aim of obtaining the 
prevalence of ASA resistance utilizing the 
platelet function test, is an endeavour that merits 

a place in this editorial. It is simple but important  
as there has not yet been a descriptive study in 
Indonesia – for such a large population – that 
takes on a problem as relevant as this. Further 
studies will have to follow in its wake, and a 
lot more data are needed to identify and stratify 
the Indonesian population. But we have to start 
somewhere and this article is a good start.

Aspirin resistance, as a phenomenon, is real. 
It is a phenomenon that – in a number of meta-
analyses – affects between 15 to 25 percent of 
the population, with a higher incidence in stroke 
patients. It has clinical consequences that burden 
the public health system, and addressing the issues 
involved will be a big contribution to the practice 
of medicine.

REFERENCES

1. Alberts MJ. Platelet function testing for aspirin 
resistance is reasonable to do. Stroke. 2010;41:2400-1.

2. Shen H, Herzog W, Drolet M, et al. Aspirin resistance 
in healthy drug-naive men versus women (from the 
Heredity and Penotype Intervention Heart Study). Am 
J Cardiol. 2009;104:606-12.

3. Kurniawan M, Harris S, Hermawan D, Prihartono J. 
Evaluating resistance to acetyl salicylic acid using 
platelet function test in patients with ischemic stroke 
at Cipto Mangunkusumo Hospital. Acta Med Indones-
Indones J Intern Med. 2015;47(2):88-94.