Buffered acetylsalicylic acid provides comparable antiplatelet activity to simple ASA and is associated with a lower risk of aspirin-induced enteropathy compared to enteric-coated formulations.
Does buffered acetylsalicylic acid improve antiplatelet efficacy and reduce gastrointestinal mucosal damage compared to enteric-coated acetylsalicylic acid?
Buffered ASA may be a preferable alternative to enteric-coated ASA due to more reliable absorption, faster antiplatelet effect, and a lower risk of aspirin-induced enteropathy.
To date, a sufficient volume of clinical studies has been accumulated that have demonstrated a reduced antiplatelet effect of enteric-coated (EC) lowdose acetylsalicylic acid (ASA). Delayed and incomplete absorption from the intestinal alkaline medium, which significantly reduces the bioavailability of drug, is considered the main reason for laboratory aspirin resistance (pseudoresistance) to EC ASA. This phenomenon is of particular importance for patients with acute coronary syndrome, when a quick effect is required, as well as for patients with diabetes and obesity due to additional causes of increased platelet activity, on the one hand, and reduced bioavailability of ASA, on the other. Given the issue of efficacy, the dubious gastroprotective effect and the more pronounced damaging effect on the mucous membrane of small intestine, the use of EC ASA should be avoided, especially in patients with a multifactorial risk of insufficient response to therapy. A good alternative is buffered ASA, which quickly dissolves and is partially absorbed directly in the stomach, having antiplatelet activity comparable to simple ASA and a similar aspirin resistance, is associated with a lower risk of aspirin-induced enteropathy in comparison with ES ASA. In addition, according to a number of small studies and retrospective analyzes, buffered ASA is less likely to cause damage to gastric mucosa compared to EC ASA.
А. В. Сидоров (Mon,) conducted a review in Acute coronary syndrome, diabetes, and obesity. Buffered acetylsalicylic acid vs. Enteric-coated acetylsalicylic acid was evaluated on Antiplatelet effect and gastrointestinal safety. Buffered acetylsalicylic acid provides comparable antiplatelet activity to simple ASA and is associated with a lower risk of aspirin-induced enteropathy compared to enteric-coated formulations.