Evaluation of aspirin resistance and its association with TBXA2R and ABCB1 polymorphisms in patients with acute coronary syndrome: a single-center case-control study

Aspirin resistance is a major clinical concern that compromises the effectiveness of antiplatelet therapy in patients with Acute Coronary Syndrome (ACS). Genetic polymorphisms, particularly in TBXA2R and ABCB1, may influence aspirin responsiveness, alongside comorbidities such as diabetes and hypertension. Understanding these factors is crucial for optimizing cardiovascular prevention strategies. To determine the association of TBXA2R (rs1131882) and ABCB1 (rs1045642) polymorphisms with aspirin resistance / nonresistance in ACS patients. This case-control study included patients of ACS from Cardiology department and was conducted in Pathology department of Mayo Hospital Lahore. Whole Blood Aggregometry using arachidonic acid as an agonist was used and aspirin-resistant ( n = 58) and non-resistant ( n = 58) patients were identified and grouped. Genotyping was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Demographic, clinical, and laboratory parameters were analyzed. Statistical tests included independent t-tests and chi-square tests with p < 0.05 considered significant. The TT genotype of TBXA2R was more prevalent in the resistant group (53.4% vs. 39.7%), though this did not reach statistical significance ( p = 0.068), while the CC genotype was more frequent in non-resistant patients (17.2% vs. 36.2%). ABCB1 polymorphisms showed no significant association. Hypertension was more common in resistant patients (75.9% vs. 67.2%), and hematocrit was significantly lower in resistant patients (39.90 ± 0.53 vs. 41.46 ± 0.51, p = 0.038). The findings suggest a potential genetic predisposition to aspirin resistance via TBXA2R polymorphisms, while ABCB1 variants were not significantly associated. Hematocrit and hypertension influenced aspirin efficacy, highlighting the need for personalized antiplatelet strategies integrating genetic and clinical risk assessment.