Key result
Shifting aspirin or P2Y12-inhibitor intake to bedtime lacks sufficient evidence to determine if it effectively overcomes early-morning platelet hyper-reactivity and prevents cardiovascular events.
Why the study?
Does shifting the time of intake or splitting the daily dose of antiplatelet drugs prevent early-morning cardiovascular events in patients receiving antiplatelet therapy?
Does shifting the time of intake or splitting the daily dose of antiplatelet drugs prevent early-morning cardiovascular events in patients receiving antiplatelet therapy?
Further research is needed to determine if a simple strategy like shifting or splitting the dose of antiplatelet drugs to the evening can prevent early-morning cardiovascular events.
Should not yet change antiplatelet timing in practice; leaves open whether bedtime dosing reduces early-morning events.
Long-term evidence supports a clustering of cardiovascular events in the early morning. Several studies have shown that platelet hyper-reactivity to various stimuli is also present at this period of the day. However, the idea of treatment strategies reflecting the circadian variation in platelet reactivity has been largely neglected so far, and this is true despite the huge number of patients being treated with these drugs. Some pharmacodynamic data suggest that early-morning platelet hyper-reactivity may be overcome by shifting aspirin intake to the bedtime. However, there is lack of evidence whether shifting the time of intake or splitting the daily dose of P2Y12-inhibitors with a regular QD dosing (clopidogrel or prasugrel) to the evening would be effective to overcome platelet hyper-reactivity or to suppress the excess of cardiovascular events observed during morning hours. Further research is warranted to clarify whether such a simple and costless effort like dose shifting or splitting may be beneficial to prevent cardiovascular events.
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Aradi et al. (2015) conducted a review in Cardiovascular events. Bedtime intake of aspirin and ADP receptor blockers vs. Morning intake was evaluated. Shifting aspirin or P2Y12-inhibitor intake to bedtime lacks sufficient evidence to determine if it effectively overcomes early-morning platelet hyper-reactivity and prevents cardiovascular events.
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