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. 2025 Aug 30:ehaf680.
doi: 10.1093/eurheartj/ehaf680. Online ahead of print.

Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial

Jean-Guillaume Dillinger  1   2   3 , Théo Pezel  1   2 , Laure Batias  4 , Denis Angoulvant  5 , Marc Goralski  6 , Emile Ferrari  7 , Guillaume Cayla  8 , Johanne Silvain  9 , Martine Gilard  10 , Gilles Lemesle  11   12   13   14 , Géraud Souteyrand  15 , Pascal Lim  16 , François Roubille  17 , Jean-Louis Georges  18 , Claire Bal Dit Sollier  3 , Thibaut Petroni  19 , Olivier Morel  20 , Nicolas Delarche  21 , Meier Elbaz  22 , Etienne Puymirat  23   24 , Solenn Toupin  1   2 , Gilles Montalescot  9 , Ludovic Drouet  3 , Eric Vicaut  25 , Patrick Henry  1 ; ANDAMAN Investigators of the ACTION Study Group
Collaborators, Affiliations

Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial

Jean-Guillaume Dillinger et al. Eur Heart J. .

Abstract

Background and aims: Despite current antithrombotic treatments, the recurrence of ischaemic events remains high in patients with diabetes mellitus (DM) or aspirin resistance after acute coronary syndrome (ACS). Whether twice-daily aspirin dosing reduces major adverse cardiovascular events (MACE) in this population remains unknown.

Methods: In this prospective multicentre, randomized trial, patients with ACS and DM or high-risk of aspirin resistance (HRAR) defined as: (i) an index event occurring while on aspirin; (ii) body mass index ≥27 kg/m2; or (iii) increased waist circumference were assigned to receive enteric-coated aspirin once daily (100 mg/day) or twice daily (100 mg morning and evening). The primary outcome was MACE, a composite of any death, myocardial infarction, stroke, urgent coronary revascularization, stent thrombosis, or acute arterial thrombotic event assessed using a time-to-first-event analysis. The main secondary outcome was major bleeding (Bleeding Academic Research Consortium type 3-5).

Results: In total, 2484 participants were enrolled (77.2% with DM, 55.5% with ST-elevation segment myocardial infarction). The median follow-up duration was 18 (interquartile range: 17.6-18.3) months. The primary outcome occurred in 95 of 1228 participants (7.7%) in the twice-daily aspirin group, and 110 of 1256 (8.8%) in the once-daily group (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.69-1.19; P = .42). Major bleeding rates were similar between the groups (1.9% vs 2.1%; HR 0.88; 95% CI 0.50-1.55).

Conclusions: In patients with ACS and DM or HRAR, twice-daily aspirin did not significantly reduce the risk of MACE compared to once-daily dosing. No significant difference was observed in major bleeding between groups.

Trial registration: NCT02520921/EUDRACT No: 2015-000947-18.

Keywords: Acute coronary syndrome; Aspirin; Aspirin resistance; Cardiovascular events; Diabetes mellitus; Myocardial infarction.

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