In Reply Dr Kuschner is concerned that the dose of aspirin selected for our lung injury prevention trial may have been subtherapeutic and poorly informed based on the supporting literature cited.1,2 A specific highlighted concern is the notable difference in study populations when comparing those previously studied with those who were enrolled in this trial (eg, healthy volunteers vs those with acute illness and risk for ARDS). Such concerns, in addition to the well-documented potential for aspirin resistance, greatly influenced the study design. Indeed, the decision to provide an initial loading dose of aspirin (325 mg) was driven by the desire to mitigate the potential for insufficient dosing of the study medication while also attempting to balance potential risks for adverse events associated with aspirin administration.
Kor DJ, Gong MN, Levy BD. Aspirin and Acute Respiratory Distress Syndrome—Reply. JAMA. 2016;316(12):1318. doi:10.1001/jama.2016.12327