Confirmation of Reported Aspirin Use in Community Studies

Q: What are the key findings of this study?

Serum thromboxane B2 (<25 ng/mL) identified aspirin use with 94.1% sensitivity and 91.1% specificity (c-statistic 0.97, P < .0001), unaffected by concurrent NSAID use.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease primary prevention (n=107). Intervention: Self-reported aspirin (ASA) use vs. No self-reported aspirin (ASA) use. Primary outcome: Serum thromboxane B2 (STxB2) level (ng/mL) (c-statistic 0.97, p=<0.0001).

Q: What does this research mean for the field?

Serum thromboxane B2 levels below 25 ng/mL accurately identify aspirin use with high sensitivity and specificity, unaffected by concurrent nonsteroidal anti-inflammatory drug use. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether serum thromboxane B2 (STxB2) measurement can reliably validate self-reported aspirin use in community-dwelling adults.

Nicole D. Zantek; Russell V. Luepker; Sue Duval; Karen Miller; Niki Oldenburg; Alan T. Hirsch

doi:10.1177/1076029613486537

May 7, 2013Clinical and Applied Thrombosis/HemostasisOpen Access

Confirmation of Reported Aspirin Use in Community Studies

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Key result

Serum thromboxane B2 identifies aspirin use with ~94% sensitivity, unaffected by concurrent NSAIDs.

c-statistic 0.97
P<0.0001
n=107

Why the study?

Does serum thromboxane B2 measurement accurately confirm reported aspirin use in a community population?

Key Points

To evaluate whether serum thromboxane B2 (STxB2) measurement can reliably validate self-reported aspirin use in community-dwelling adults.
Cross-sectional survey and blood draw conducted in 107 adults (males aged 45 to 79 years, females aged 55 to 79 years) grouped by reported aspirin use (56 ASA+ and 51 ASA-) and potential interfering medication use (INT).
Measured STxB2 using an enzyme immunoassay kit and conducted receiver operating characteristic analysis to evaluate diagnostic performance.
STxB2 levels were significantly lower in reported aspirin users than non-users: ASA+ INT- 3.0 (0.7, 8.4) ng/mL, ASA+ INT+ 2.0 (0.8, 4.9) ng/mL, ASA- INT+ 176 (75, 390) ng/mL, and ASA- INT- 271 (199, 366) ng/mL (overall ASA+ 2.1 [0.8, 5.3] ng/mL vs ASA- 252 [169, 380] ng/mL, P < .0001).
Interfering medication use, including NSAIDs, showed no significant difference in STxB2 levels between users and non-users (ASA+ INT+ vs ASA+ INT-, P = .47; ASA- INT+ vs ASA- INT-, P = .13).
A STxB2 cut point of 25 ng/mL demonstrated a c-statistic of 0.97, with 94.1% sensitivity and 91.1% specificity for discriminating aspirin use.

Study Design

Type

Cross-Sectional (n=107)

Multicenter

No

Structured PICO

Does serum thromboxane B2 measurement accurately confirm reported aspirin use in a community population?

P

Population

107 healthy adults (men aged 45-79 years and women aged 55-79 years) evaluated in a cross-sectional study of self-reported aspirin use within the prior 7 days.

E

Exposure

Reported aspirin (ASA) use

C

Comparator

Reported non-use of aspirin

O

Outcome

Serum thromboxane B2 (STxB2) levelssurrogate

Main Result

Effect estimate: c-statistic 0.97

Absolute Event Rate: 2.1% vs 252%

p-value: p=<0.0001

Serum thromboxane B2 is a reliable biomarker with high sensitivity and specificity to confirm aspirin exposure in population-based studies.

Limitations

Small sample size with insufficient power to evaluate the influence of ASA dose and timing of last dose on STxB2 levels
Timing between the administration of ASA, possible interfering drugs, and blood collection was not standardized
Conducted primarily in healthy participants, and exposure to other platelet-affecting medications (e.g., clopidogrel, dipyridamole) was not captured
Use of ASA was not confirmed by an independent reference method other than STxB2 or observed pill ingestion

Implication

Serum thromboxane B2 may verify aspirin exposure in community cohorts; leaves open its role in clinical adherence monitoring.

Abstract

Aspirin (ASA) is recommended for the prevention of cardiovascular disease; however, the compliance is low. Reported use may not reflect actual use. Serum thromboxane B2 (STxB2) measurement was evaluated to validate reported ASA use. Males aged 45 to 79 years and females aged 55 to 79 years completed a survey and STxB2 measurement (Thromboxane B2 EIA Kit; Cayman Chemical, Ann Arbor, Michigan). The 107 patients were grouped by use of ASA (56 ASA+ and 51 ASA-) and possible interfering medications (INT) such as nonsteroidal anti-inflammatory drugs. The STxB2 levels (ng/mL) were significantly lower in ASA users: ASA+ INT- 3.0 (0.7, 8.4), ASA+ INT+ 2.0 (0.8, 4.9), ASA- INT+ 176 (75, 390), and ASA- INT- 271 (199, 366). The INT use did not cause a significant difference in STxB2 levels. A STxB2 cut point of 25 ng/mL had high sensitivity (94.1%) and specificity (91.1%) for ASA use. The STxB2 was a reliable marker of ASA use and could be used to confirm ASA exposure in population-based health studies.

Discussion

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Cite This Study

Zantek et al. (2013) conducted a cross-sectional in Cardiovascular disease primary prevention (n=107). Self-reported aspirin (ASA) use vs. No self-reported aspirin (ASA) use was evaluated on Serum thromboxane B2 (STxB2) level (ng/mL) (c-statistic 0.97, p=<0.0001). Serum thromboxane B2 (<25 ng/mL) identified aspirin use with 94.1% sensitivity and 91.1% specificity (c-statistic 0.97, P < .0001), unaffected by concurrent NSAID use.

synapsesocial.com/papers/6a7c5eeb52b1b26805400ebe https://doi.org/10.1177/1076029613486537

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Confirmation of Reported Aspirin Use in Community Studies

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Confirmation of Reported Aspirin Use in Community Studies

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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