Coronary disease & ACSRandomised controlled trial
Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial
- Randomised controlled trial
- prospective
- multicentre
Authors' conclusion
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.
Study context
- Population
- Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) or high risk of aspirin resistance (index event on aspirin, BMI ≥27 kg/m², or increased waist circumference)77.2% with DM
- Participants
- 2,484 patients
- Comparison
- Twice-daily vs once-daily enteric-coated aspirin
- Twice-daily aspirinn = 1,228
- Once-dailyn = 1,256reference
- Primary endpoint
- Major adverse cardiovascular events (MACE) (any death, MI, stroke, urgent coronary revascularization, stent thrombosis or acute arterial thrombotic event), time-to-first-event
- Follow-up
- Median 18 months
Primary result
As reported in the abstract
Hazard ratio
0.90
95% CI 0.69–1.19
P = 0.42
Events by treatment group
Twice-daily aspirin vs Once-daily
HR 0.90 (95% CI 0.69–1.19); P = 0.42
Safety
Major bleeding (BARC type 3-5); main secondary outcome
- Major bleeding rates similar between the groups (1.9% vs 2.1%)
- HR 0.88; 95% CI 0.50-1.55
Original publication
Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial. Eur Heart J. Published 30 August 2025. doi:10.1093/eurheartj/ehaf680
Summarised from the published abstract; every number is checked against it