Lit Review

How an incorrect review of the literature in a single article in the medical literature could potentially adversely affect patient care

Summary of the problem with this study:

Though taking low dose aspirin repetitively on a daily basis is effective, a higher dose is needed when platelets require prompt inhibition with the first initial dose of aspirin.

A study was published by Dabaghi¹ et al suggesting that a single low dose of aspirin was effective for platelet inhibition. Though their experimental data was excellent, an inaccurate review in their article of the prior studies regarding aspirin led to the incorrect conclusion that a single pill of low dose aspirin provided the full platelet inhibitory effects achievable with aspirin.

The authors of the study very appropriately advised not using a single dose of low dose aspirin for acute coronary syndrome patients until further research was done in that study population. However, other physicians reading the study potentially might not have been so prudent.

1 Effects of Low-Dose Aspirin on In Vitro Platelet Aggregation in the Early Minutes After Ingestion in Normal Subjects. Dabaghi S, Kamat S, Payne J, Marks G, Roberts R, Schafer A, Kleiman N. Am J Cardiol 1994; 74:720-733.

A study was published showing that a single low dose of aspirin was effective in inhibiting platelets in a certain fashion. However, because the authors incorrectly reviewed prior studies, they erroneously suggested all the important effects of aspirin were achieved with this low single dose of aspirin. This issue was important because patients presenting with a heart attack need the full benefit of aspirin.

Details of the misunderstanding of the effects of a single dose of aspirin on platelets.

Letters to the editor and to the authors can help correct errors in the literature:

Subsequent letter published in the American Journal of Cardiology¹ explaining how a more accurate review of the literature showed that a single low dose aspirin did not fully inhibit platelets. (The authors of the initial study submitted no reply.)
1. Roehm E., Am J Cardio 1995; 76:637-638

Letter sent to the authors (S. Dabaghi M.D., Robert Roberts M.D) at the same time the letter for publication was submitted to the American Jl. of Cardiology in order to influence the authors' opinions directly.

1. Effects of Low-Dose Aspirin on In Vitro Platelet Aggregation in the Early Minutes After Ingestion in Normal Subjects. Dabaghi S, Kamat S, Payne J, Marks G, Roberts R, Schafer A, Kleiman N. Am J Cardiol 1994; 74:720-733.