Aspirin treatment failure: is this a real phenomenon? A review of the aetiology and how to treat it

Multiple clinical trials have shown that aspirin can reduce all cardiovascular events in primary and secondary prevention and yet there is a large population in whom aspirin fails. This review brings together the evidence and controversies surrounding the definition of ‘aspirin treatment failure’, its clinical significance and the possible approaches to managing such patients. Several different assays have been developed to measure the biochemical action of aspirin. At present there is no ‘gold standard’ and there is massive disparity between methods. Studies thus far have shown inconsistent results and to date the treatment of aspirin therapy failure is left to the discretion of the leading physician.