Patients with Essential Thrombocythemia may be Poor Responders to Enteric-Coated Aspirin, but not to Plain Aspirin

Essential thrombocythemia (ET) patients are treated with aspirin (acetylsalicylic acid [ASA]) to prevent thrombosis. Previous studies showed that serum thromboxane (Tx) B (2) was high 24hours after enteric-coated (EC)-ASA in ET patients, due to increased number of noninhibited reticulated platelets (RPs), consequent to high platelet turnover, and that ASA should be given twice a day to ET patients. We studied ET patients ( n =17) and healthy subjects ( n =10) on 100mg EC-ASA once daily; experiments were repeated after 14-day treatment with 100mg plain-ASA once daily. Serum TxB (2) , plasma ASA, and salicylic acid (SA) were measured before the morning dose and up to 8hours thereafter. Blood activity of ASA-deacethylating esterases, in vitro inhibition of collagen-induced TxB (2) production by ASA (10-1,000 mu M), and number of RP were measured. TxB (2) inhibition by ASA in vitro and esterases activities were normal in all subjects. EC-ASA elicited highly variable responses; 6 ET patients were poor responders, as their serum TxB (2) was high after EC-ASA; their plasma levels of ASA and SA were low/undetectable. In contrast to EC-ASA, plain ASA decreased serum TxB (2) and increased plasma ASA and SA in all subjects. Serum TxB (2) was high in ET patients at 24hours and significantly correlated with RP count (but not RP percentage) and platelet count. Plain ASA should be used in ET patients to inhibit platelets efficiently. The identification of ET patients who might benefit from twice a day ASA could simply be based on their platelet count: since their platelet turnover is not increased, ET patients with normalized platelet count should not need twice a day ASA treatment.