To compare the newer inductor of platelet aggregation cationic propyl gallate (CPG) with adenosine diphosphate (ADP) for the examination of aspirin (ASA) effectivity with optical aggregometry. In total,116 patients were prospectively enrolled with a stable cardiovascular disease, taking ASA 100 mg/day for >or=1 month. The control group consisted of 62 healthy volunteers. A platelet aggregation was investigated by optical aggregometry (aggregometer LASER 4x; BIO ART, Sint-Katelijne-Waver, Belgium). CPG and ADP were added as aggregating agents. The measured parameters were CPG-slope (%/min) and ADP max (%). Using the CPG-slope values from the control group, the CPG-slope cut-off value was determined to define a laboratory ASA-noneffectively treated patient. The values from control group followed a normal distribution (Shapiro-Wilk test). We calculated the cut-off value using the 1-tailed 95% confidence interval. The CPG-slope cut-off value was 79 %/min for an ASA-effectively treated patient. We marked the patients as laboratory ASA-noneffective treated when the CPG-slope was >79%/min. In the same way we defined the cut-off value for ADP-max. We identified the aspirin treatment as ineffective when the value of ADP-max was >62%. The values of CPG-slope and ADP-max were in close correlation in the group of patients treated with aspirin with a highly significant correlation index (r=0.671, P<0.001). By CPG-induced optical aggregation, 33,6% were ASA-noneffectively treated patients. When using both inductors, the proportion of ASA-noneffectively treated patients was 25%. Using both tests, 72.4% of patients were equally divided. ASA-noneffectively treated patients were commonly more obese (46.2%), had hypertension (94.9%) and hypercholesterolemia (73.7%), and were less commonly treated with statins (30.8%) than the aspirin effectively treated patients (42%, 88.2%, 59.2%, and 42.1%, respectively). The detected differences were not statistically significant. Cationic propyl gallate is an optimal inductor for optical aggregometry to monitor laboratory effectiveness of aspirin therapy in routine clinical pratice. The determined high prevalence of laboratory aspirin ineffectiveness highlights the clinical importance of the problem. This study brings attention to the importance of controlling cardiovascular risk factors.

Cardiocentre 3rd Medical School Charles University Prague Czech Republic and the Clinic of Haematologie University Hospital Bratislava Slovak Republic