Key result
In patients with coronary artery disease and arterial hypertension, bedtime dosing of acetylsalicylic acid significantly reduced platelet aggregation by 28 Aspirin Reaction Units compared to morning dosing.
Why the study?
ASA is typically dosed in the morning for CAD secondary prevention, but morning peaks in platelet aggregation may drive myocardial infarctions and strokes, prompting evaluation of morning versus evening dosing.
Does evening dosing of acetylsalicylic acid reduce platelet aggregation compared to morning dosing in patients with coronary artery disease and arterial hypertension?
RCT (n=175)
Randomly assigned
No
Does evening dosing of acetylsalicylic acid reduce platelet aggregation compared to morning dosing in patients with coronary artery disease and arterial hypertension?
Mean Difference: -27.52
Absolute Event Rate: 460.1% vs 487.62%
p-value: p=<0.05
Bedtime dosing of acetylsalicylic acid significantly reduces platelet aggregation compared to morning dosing in patients with CAD and hypertension, with a particularly pronounced benefit in women.
Supports bedtime aspirin dosing to optimize antiplatelet effects in CAD with hypertension; extends chronotherapy evidence from prior RCTs.
BACKGROUND: Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention of coronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggested that the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctions and strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening) dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH). METHODS: The study involved 175 patients with CAD and AH. Patients were randomly assigned to one of two study groups, taking ASA in the morning or in the evening. The patients had two visits, one baseline and another after 3 months from changing the time of ASA dosage. The platelet aggregation was determined using the VerifyNow analyzer. RESULTS: In the ASA evening group, a significant reduction in platelet aggregation was obtained. In the ASA morning group, a significant difference in response to ASA was observed, depending on sex. In men, the reactivity of platelets decreased, but in women it increased. CONCLUSIONS: In the group of patients with CAD and AH, bedtime ASA dosing is associated with a significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefit gained by changing the drug administration from the morning to the evening is greater in women.
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Krasińska et al. (2018) conducted an RCT in Coronary artery disease and arterial hypertension (n=175). Acetylsalicylic acid (ASA) evening dosing vs. Acetylsalicylic acid (ASA) morning dosing was evaluated on Platelet aggregation (Aspirin Reaction Units, ARU) (MD -27.52, p=<0.05). In patients with coronary artery disease and arterial hypertension, bedtime dosing of acetylsalicylic acid significantly reduced platelet aggregation by 28 Aspirin Reaction Units compared to morning dosing.
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