Author + information
- Deepak L. Bhatt, MD, MPH∗ (, )
- Tilo Grosser, MD,
- Jing-fei Dong, MD, PhD,
- Douglas Logan, MD,
- Walter Jeske, PhD,
- Dominick J. Angiolillo, MD, PhD,
- Andrew L. Frelinger III, PhD,
- Juan Liang, PhD,
- Byron Cryer, MD and
- Upendra Marathi, PhD
- ↵∗Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115
Drs. Cerit and Duygu raise an interesting question of whether diabetic gastroparesis may play a role in apparent “aspirin resistance” in diabetic patients (1). It is possible that in some patients, diabetic gastroparesis impairs absorption of a number of enteric-coated (EC) drugs, including EC aspirin. Indeed, the incidence of gastroparesis in patients with diabetes may be as high as 30% to 40% (2). Because blood glucose is important in regulating gastric emptying, as well as other factors, it is possible that patients treated with EC aspirin have variable gastric emptying and a higher frequency of prolonged tablet retention in the stomach (3). With a greater gastric residence time, the amount of aspirin available to be dissolved and absorbed in the upper gastrointestinal tract may be lower after EC aspirin than after immediate-release forms. In patients with diabetic gastroparesis, the lower rate and extent of aspirin absorption could conceivably be magnified. It is also possible that patients with diabetic gastroparesis have more advanced diabetes, and are therefore more likely to have heightened platelet activity. This potential effect on platelets may then appear to manifest as “aspirin resistance” as well (4). However, our study did not explicitly evaluate the presence or absence of diabetic gastroparesis, though the 2 non-EC aspirin formulations studied did not appear to have any issues with impaired absorption (5). As such, more work is certainly needed on defining the optimal antiplatelet therapy in diabetic patients.
Please note: This study was funded by PLx Pharma, Inc. Dr. Bhatt has served on the advisory board for Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; on the board of directors for Boston VA Research Institute and Society of Cardiovascular Patient Care; as chair for the American Heart Association Quality Oversight Committee; on data monitoring committees for Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org), Belvoir Publications (editor in chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (editor in chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor and associate editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), and WebMD (CME steering committees); served as deputy editor for Clinical Cardiology; served as chair for the NCDR-ACTION Registry Steering Committee, and VA CART Research and Publications Committee; has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as a site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical; has served as a trustee for the American College of Cardiology; and has performed unfunded research for FlowCo, PLx Pharma Inc., and Takeda. Dr. Grosser has received consulting fees from Plx Pharma, Bayer Healthcare, and Alarez Pharmaceuticals. Dr. Jeske is the principal investigator on a research grant to Loyola University Chicago from BioData Corporation; and is a consultant to PLx Pharma, Machaon Diagnostics, and Repros Therapeutics. Dr. Angiolillo has received consulting fees or honoraria from Amgen, Bayer, Pfizer, Sanofi, Daiichi-Sankyo, Eli Lilly and Company, The Medicines Company, AstraZeneca, Merck, Abbott Vascular, and PLx Pharma; fees or honoraria for participation in review activities from CeloNova, Johnson & Johnson, and St. Jude Medical; and (institutional) payments for grants from GlaxoSmithKline, Daiichi-Sankyo, Eli Lilly and Company, The Medicines Company, AstraZeneca, Janssen Pharmaceuticals, Osprey Medical, Novartis, CSL Behring, and Gilead. Dr. Frelinger is the principal investigator or coinvestigator on research grants to Boston Children’s Hospital from Baxalta, Bristol-Myers Squibb, Eisai, Eli Lilly, Daiichi-Sankyo, GE Healthcare, GLSynthesis, Pfizer, and Sysmex; and is a consultant to PLx Pharma. Dr. Marathi is an investor, officer, and employee of PLx Pharma Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Bhatt D.L.
- Bhatt D.L.
- Bhatt D.L.,
- Grosser T.,
- Dong J.F.,
- et al.