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[Comment] Weight-adjusted aspirin for cardiovascular prevention

Understanding the sources of variability in patients’ responses to medicines has the potential to improve efficacy and safety through personalisation of treatment. Individual factors—ie, a patient’s risk of cardiovascular events—are already considered when deciding who is prescribed low-dose aspirin for cardiovascular prevention. However, aspirin inhibits just one of several pathways of platelet activation, so it is not surprising that many patients still experience cardiovascular events.1 Factors that potentially contribute to these treatment failures, sometimes named as aspirin resistance, have been studied extensively, and several plausible mechanisms have been suggested, including non-adherence,2 accelerated platelet turnover in patients with diabetes,3 drug interactions with non-steroidal anti-inflammatory drugs,4 reduced bioavailability due to enteric coating,5,6 and bodyweight.