Key result
Enteric-coated aspirin leaves ~20% of diabetic patients with high 24-hour platelet reactivity.
Why the study?
The role and pharmacodynamics of low-dose enteric-coated aspirin in primary prevention among patients with type 2 diabetes without atherosclerotic disease remain unclear.
Does 81 mg of enteric-coated aspirin once daily effectively inhibit platelet function over 24 hours in patients with type 2 diabetes without atherosclerotic disease?
Does 81 mg of enteric-coated aspirin once daily effectively inhibit platelet function over 24 hours in patients with type 2 diabetes without atherosclerotic disease?
In patients with type 2 diabetes for primary prevention, once-daily 81 mg enteric-coated aspirin resulted in incomplete platelet inhibition at 24 hours in 20% of participants, suggesting alternative regimens may be required.
20% incomplete 24-hour inhibition suggests possible once-daily limitations; hypothesis-generating for regimen optimization before practice change.
Background Diabetes is a major cardiovascular risk factor. Although aspirin is recommended for secondary prevention, its role in primary prevention among patients with diabetes remains unclear. The APPEASED trial aimed to evaluate aspirin's pharmacokinetics and pharmacodynamics in this population. Methods In this single-arm, open-label trial, 50 patients with type 2 diabetes and no evidence of atherosclerotic disease, received 81 mg of enteric-coated aspirin once daily for 7 days. Platelet function was assessed at baseline and on day 7 using light transmission aggregometry in response to arachidonic acid (primary endpoint) and measurement of circulating thromboxane B2 (TxB2) level (secondary endpoint). Oxidative stress markers, COX-1 acetylation, and COX-2 expression were also measured to explore mechanisms of on-treatment platelet reactivity. Results Ten participants (20%) exhibited high on-treatment platelet reactivity 24 hours after 6 days of aspirin. However, all showed complete platelet inhibition 2 hours after observed ingestion on day 7. Despite variability in platelet reactivity, COX-1 acetylation and TxB2 suppression were consistent across participants. No significant differences were found in oxidative stress markers or COX-2 expression. Conclusion In patients with type 2 diabetes in primary prevention, low-dose enteric-coated aspirin consistently achieved platelet inhibition shortly after ingestion, 20% of participants showed incomplete inhibition at 24 hours, despite adequate COX-1 acetylation and TxB2 suppression. These findings suggest that alternative aspirin regimens may be needed to ensure continuous platelet inhibition and optimize cardiovascular prevention in this high-risk population.
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Lipp et al. (2026) studied Type 2 diabetes in primary prevention (n=50). Enteric-coated aspirin was evaluated on Platelet function assessed by light transmission aggregometry in response to arachidonic acid. Enteric-coated aspirin 81 mg daily resulted in high on-treatment platelet reactivity at 24 hours in 20% of patients with type 2 diabetes, despite complete inhibition 2 hours post-ingestion.
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