• Mudassar Noor Pharmacology Department Army Medical College
  • Usman Nawaz
  • Saleem Ahmad Khan
  • Akbar Waheed
  • Chaudhry Altaf
Keywords: Aspirin resistance, smoking, platelet aggregation


Background: Cigarette smoking stimulates platelet activation and aggregation and can also influence adversely the antiplatelet effects of aspirin, which is the mainstay of treatment in the primary and secondary prevention of ischemic heart disease. This study was carried out to analyze the effect of smoking on aspirin efficacy in coronary heart disease patients. Methods: In this cross sectional analytical study, 384 ischemic heart disease patients were enrolled. Light transmission Aggregometry (LTA) with arachidonic acid was utilized to assess the platelet function. Data was analyzed using SPSS-23. Chi-square test Odds Ratio were utilized to find out association of smoking with aspirin response status. Results: The study contained 272 (70.8%) male and 112 (29.2%) females with the mean age of 48.22±11.87 years. There were 199 smokers (51.82%) and 185 non-smokers (48.18%). Frequency of aspirin resistant among smokers was 41 (20.60%) whereas the frequency in non-smokers was 12 (6.50) and the difference was significant (p<0.001). The adjusted Odds Ratio was 4.44 with 95% confidence interval of 2.07–8.90. Frequency comparison of aspirin responders between males and females was non-significant both in, smokers and non-smokers (p=0.14 and 0.92 respectively). Conclusion: Cigarette smoking adversely affects the antiplatelet efficacy of aspirin irrespective of gender.

Author Biographies

Usman Nawaz

Assoc Prof, Pharmacology Department, Pak International Medical College, Peshawar

Saleem Ahmad Khan

Principal & Dean Army Medical College, Professor of Pathology, National University of Medical Sciences (NUMS) Rawalpindi

Akbar Waheed

Professor of Pharmacology and PhD supervisor, Pharmacology Department, Amry Medical College, National University of Medical sciences (NUMS) Rawalpindi

Chaudhry Altaf

Consultant Hematologist, Armed Focres Institute of Pathology (AFIP), National University of Medical sciences (NUMS) Rawalpindi


1. Zupanets I, Zaprovalna OY, Grintsov IF, Otrishko I. Differences of the antiplatelet treatment with acetylsalicylic acid. Clin Pharm 2016;20(4):11–6.
2. Godley RW, Hernandez-Vila E. Aspirin for Primary and Secondary Prevention of Cardiovascular Disease. Tex Heart Inst J 2016;43(4):318–9.
3. Schrör K. Pharmacology and cellular/molecular mechanisms of action of aspirin and non-aspirin NSAIDs in colorectal cancer. Best Pract Res Clin Gastroenterol 2011;25(4-5):473–84.
4. Cai G, Zhou W, Lu Y, Chen P, Lu Z, Fu Y. Aspirin resistance and other aspirin-related concerns. Neurol Sci 2016;37:181–9.
5. Li W, Zhang HY, Miao CL, Tang RB, Du X, Shi JH, et al. Cigarette smoking inhibits the anti-platelet activity of aspirin in patients with coronary heart disease. Chin Med J 2011;124:1569–72.
6. Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 2014;34:509–15.
7. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004;43(10):1731–7.
8. Burns D. Cigarettes and cigarette smoking. Clin Chest Med 1991;12(4):631–42.
9. Bernhard D, (Ed). Cigarette smoke toxicity: Linking individual chemicals to human diseases. Singapur: John Wiley & Sons; 2011.
10. Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ 1989;298:784–8.
11. Freedman DS, Srinivasan SR, Shear CL, Hunter SM, Croft JB, Webber LS, et al. Cigarette smoking initlation and longitudinal changes in serum lipids and lipopoproteins in early adulthood the bogalusa heart study. Am J Epidemiol 1986;124(2):207–19.
12. Nakamura K, Barzi F, Huxley R, Lam TH, Suh I, Woo J, et al. Does cigarette smoking exacerbate the effect of total cholesterol and high-density lipoprotein cholesterol on the risk of cardiovascular diseases? Heart 2009;95(11):909–16.
13. Barbieri SS, Zacchi E, Amadio P, Gianellini S, Mussoni L, Weksler BB, et al. Cytokines present in smokers' serum interact with smoke components to enhance endothelial dysfunction. Cardiovasc Res 2011;90(3):475–83.
14. Csordas A, Bernhard D. The biology behind the atherothrombotic effects of cigarette smoke. Nat Rev Cardiol 2013;10(4):219–30.
15. Barua RS, Ambrose JA. Mechanisms of coronary thrombosis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol 2013;33(7):1460–7.
16. Massberg S, Gawaz M, Grüner S, Schulte V, Konrad I, Zohlnhöfer D, et al. A crucial role of glycoprotein VI for platelet recruitment to the injured arterial wall in vivo. J Exp Med 2003;197(1):41–9.
17. Dubois C, Panicot-Dubois L, Merrill-Skoloff G, Furie B, Furie BC. Glycoprotein VI–dependent and–independent pathways of thrombus formation in vivo. Blood 2006;107(10):3902–6.
18. Vu TK, Hung DT, Wheaton VI, Coughlin SR. Molecular cloning of a functional thrombin receptor reveals a novel proteolytic mechanism of receptor activation. Cell 1991;64(6):1057–68.
19. Davis JW, Davis RF. Acute effect of tobacco cigarette smoking on the platelet aggregate ratio. Am J Med Sci 1979;278(2):139–43.
20. Davis JW, Hartman CR, Shelton L, Ruttinger HA. A trial of dipyridamole and aspirin in the prevention of smoking-induced changes in platelets and endothelium in men with coronary artery disease. Am J Cardiol 1989;63(20):1450–4.
21. WHO. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.
22. Sandhya M, Satyanarayana U, Mohanty S, Basalingappa DR. Impact of chronic cigarette smoking on platelet aggregation and coagulation profile in apparently healthy male smokers. Int J Clin Exp Physiol 2015;2(2):128–33.
23. Mirkhel A, Peyster E, Sundeen J, Greene L, Michelson AD, Hasan A, et al. Frequency of aspirin resistance in a community hospital. Am J Cardiol 2006;98(5):577–9.
24. Pamukcu B, Oflaz H, Onur I, Cimen A, Nisanci Y. Effect of cigarette smoking on platelet aggregation. Clin Appl Thromb Hemost 2011;17(6):E175–80.
25. Brockmann MA, Beythien C, Magens MM, Wilckens V, Kuehnl P, Gutensohn K. Platelet hemostasis capacity in smokers: in vitro function analyses with 3.2% citrated whole blood. Thromb Res 2001;104(5):333–42.
26. Scheinichen D, Heuft HG, Renken C, Jüttner B, Jaeger K, Schürholz T, et al. Impact of tobacco smoking on platelet function in apheresis products in vitro. Vox Sang 2004;86(4):252–6.
27. Ikonomidis I, Lekakis J, Vamvakou G, Andreotti F, Nihoyannopoulos P. Cigarette smoking is associated with increased circulating proinflammatory and procoagulant markers in patients with chronic coronary artery disease: effects of aspirin treatment. Am Heart J 2005;149(5):832–9.
28. Bliden KP, Dichiara J, Lawal L, Singla A, Antonino MJ, Baker BA, et al. The association of cigarette smoking with enhanced platelet inhibition by clopidogrel. J Am Coll Cardiol 2008;52(7):531–3.


Download data is not yet available.
How to Cite
Noor M, Nawaz U, Khan S, Waheed A, Altaf C. IMPACT OF SMOKING ON ANTI-PLATELET EFFECTS OF ASPIRIN. PJP [Internet]. 20Aug.2018 [cited 16Jul.2019];14(3):3-. Available from: