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Lemesle G, Schurtz G, Meurice T, Tricot O, Lemaire N, Caudmont S, Philias A, Ketelers R, Lamblin N, Bauters C. Clopidogrel Use as Single Antiplatelet Therapy in Outpatients with Stable Coronary Artery Disease: Prevalence, Correlates and Association with Prognosis (from the CORONOR Study). Cardiology 2016; 134:11-8. [DOI: 10.1159/000442706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
Background: Clopidogrel use as single antiplatelet therapy (SAPT) has never been evaluated in stable coronary artery disease (CAD) outpatients either as compared to placebo or aspirin. Methods: We therefore studied 2,823 outpatients included in a prospective registry. The patients were divided into 2 groups according to their antiplatelet therapy regimen: patients treated with clopidogrel were compared with those treated with aspirin alone. Results: The mean time since CAD diagnosis was 7.9 years. Altogether, 776 (27.5%) patients received clopidogrel as SAPT. Factors independently associated with clopidogrel use were prior aortic or peripheral intervention, drug-eluting stent implantation, stroke, carotid endarterectomy and time since CAD diagnosis. Clopidogrel tended to be used in higher-risk patients: composite of cardiovascular death, myocardial infarction or stroke at 5.8 versus 4.2% (p = 0.056). However, after propensity score matching, similar event rates were observed between the groups: 5.9% when treated with clopidogrel versus 4.4% with aspirin (p = 0.207). The rate of bleeding was also similar between the groups. Conclusions: Our study shows that a significant proportion of stable CAD patients are treated with clopidogrel as SAPT in modern practice. Several correlates of such an attitude were identified. Our results suggest that this strategy is not beneficial as compared to aspirin alone in terms of ischaemic or bleeding events.
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Abstract
Diabetes imparts a substantial increased risk for cardiovascular disease-related mortality and morbidity. Because of this, current medical guidelines recommend prophylactic treatment with once-daily, low-dose aspirin (acetylsalicylic acid) for primary and secondary prevention of cardiovascular (CV) events in high-risk patients. However, only modest reductions in CV events and mortality have been observed with once-daily aspirin treatment in patients with diabetes, including patients with a previous CV event, perhaps because of disparity between aspirin pharmacokinetics and diabetes-related platelet abnormalities. Once-daily aspirin irreversibly inactivates platelets for only a short duration (acetylsalicylic acid half-life, approximately 15-20 minutes), after which time newly generated, active platelets enter the circulation and weaken aspirin's effect. Platelets from patients with diabetes are more reactive and are turned over more rapidly than platelets from normal individuals; the short inhibitory window provided by once-daily aspirin may therefore be insufficient to provide 24-h protection against CV events. Alternative conventional aspirin regimens (e.g. higher daily dose, twice-daily dosing, combination with clopidogrel) and newer formulations (e.g. 24-h, extended-release) have been proposed to overcome the apparent limited efficacy of conventional aspirin in patients with diabetes; however, tolerability concerns and limited clinical efficacy data need to be taken into account when considering the use of such regimens.
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Patrono C. The Multifaceted Clinical Readouts of Platelet Inhibition by Low-Dose Aspirin. J Am Coll Cardiol 2015; 66:74-85. [PMID: 26139061 DOI: 10.1016/j.jacc.2015.05.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/21/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
Inactivation of platelet cyclooxygenase (COX)-1 by low-dose aspirin leads to long-lasting suppression of thromboxane (TX) A2 production and TXA2-mediated platelet activation and aggregation. This effect is necessary and sufficient to explain aspirin's unique (among other COX-1 inhibitors) effectiveness in preventing atherothrombosis, as well as its shared (with other antiplatelet agents) bleeding liability. However, different mechanisms of action have been suggested to explain other beneficial effects of aspirin, such as prevention of venous thromboembolism, chemoprevention of colorectal (and other) cancers, and reduced risk of dementia. These mechanisms include acetylation of other proteins in blood coagulation, inhibition of COX-2 activity, and other COX-independent mechanisms. The intent of this review is to develop the concept that the multifaceted therapeutic effects of low-dose aspirin may reflect pleiotropic consequences of platelet inhibition on pathophysiological tissue repair processes. Furthermore, the clinical implications of this concept will be discussed in terms of current clinical practice and future research.
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Affiliation(s)
- Carlo Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy.
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Bem D, Dretzke J, Stevens S, Lordkipanidzé M, Hodgkinson J, Bayliss S, Moore D, Fitzmaurice D. Investigating the effectiveness of different aspirin dosing regimens and the timing of aspirin intake in primary and secondary prevention of cardiovascular disease: protocol for a systematic review. Syst Rev 2015; 4:88. [PMID: 26088608 PMCID: PMC4475616 DOI: 10.1186/s13643-015-0078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Once-daily low-dose aspirin is routinely used for the prevention of secondary events in cardiovascular disease (CVD). The routine use of aspirin in primary prevention of CVD is less clear due to a finer balance between benefits and harms. In addition, the variability in benefit achievable from the prescription of aspirin has led to a growing interest in considering whether there are more effective aspirin regimens than once-daily dosing or whether effectiveness is influenced by the time of day aspirin is taken (chronotherapy). The proposed systematic review will evaluate the evidence on the effects of different aspirin regimens used in terms of number of doses (e.g. split or alternate dosing) or dosing time of aspirin (e.g. morning versus evening) in primary and secondary prevention of CVD. METHODS/DESIGN Standard systematic review methodology will be employed for study identification, selection and data extraction. Electronic databases will be searched incorporating terms relating to population and the intervention. No date or language limitations will apply. Systematic reviews and controlled studies comparing different aspirin regimens-in terms of frequency or timing-for primary and/or secondary prevention of CVD will be included. No restrictions on outcome will apply. Quality assessment will be appropriate for each study design. The data will be tabulated and narratively synthesised. Meta-analysis may be undertaken where clinical and methodological homogeneity exists. DISCUSSION There are a number of published and ongoing primary studies that investigate the cardiovascular protective effect of different aspirin regimens. However, no systematic review to date has attempted to review the evidence pertaining to aspirin dosing regimens differing in frequency and/or in timing. The proposed systematic review will cover both the above questions and could potentially be beneficial for reconsidering the current practice of managing patients with aspirin in primary care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014010596.
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Affiliation(s)
- Danai Bem
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - Simon Stevens
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Marie Lordkipanidzé
- Montreal Heart Institute, Research Centre, 5000 rue Bélanger, Montréal, QC, H1T 1C8, Canada. .,Faculté de pharmacie, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, H3C 3J7, Canada.
| | - James Hodgkinson
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sue Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - David Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Amsallem M, Manzo-Silberman S, Dillinger JG, Sideris G, Voicu S, Bal dit Sollier C, Drouet L, Henry P. Predictors of high on-aspirin platelet reactivity in high-risk vascular patients treated with single or dual antiplatelet therapy. Am J Cardiol 2015; 115:1305-10. [PMID: 25759104 DOI: 10.1016/j.amjcard.2015.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 11/17/2022]
Abstract
Aspirin is the key treatment in the secondary prevention of atherothrombosis. Interindividual variability of response has been linked to a higher risk for ischemic events. The aim of this study was to identify clinical and biologic factors predicting high on-aspirin platelet reactivity (HPR) in a high-risk, "real-world" population of vascular patients. All platelet testing performed from 2011 to 2013 in consecutive patients receiving long-term treatment with aspirin for coronary or cerebrovascular disease was retrospectively analyzed. Indications for platelet testing were recurrent ischemic events or high-risk angioplasty. HPR was defined as aggregation intensity≥20% using light-transmission aggregometry with arachidonic acid 0.5 mg/ml. Collagen-epinephrine platelet function analysis was also performed (threshold<165 seconds). Cardiovascular risk factors, usual biologic parameters, and antiplatelet treatment were recorded. A total of 1,508 patients were included (mean age 63 years, 71% men, 23% with diabetes). Antiplatelet treatment was aspirin alone in 333 patients and dual-antiplatelet therapy in 1,175 patients. HPR was found in 11.1% of patients. In multivariate analysis, independent predictive factors of HPR on light-transmission aggregometry with arachidonic acid were diabetes mellitus (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.39 to 3.16), age (OR 1.25, 95% CI 1.06 to 1.47), fibrinogen level (OR 1.20, 95% CI 1.02 to 1.42), and von Willebrand factor level (OR 1.06, 95% CI 1.03 to 1.09). On light-transmission aggregometry with arachidonic acid and collagen-epinephrine platelet function analysis, fibrinogen remained the main factor associated with HPR (OR 1.33, 95% CI 1.19 to 1.61). Similar results were found in patients treated with aspirin alone or dual-antiplatelet therapy. A fibrinogen level>4.0 g/L was associated with a 3.9-fold increased risk for HPR in patients aged <75 years. In conclusion, fibrinogen level was the major predictor of HPR on aspirin in this large population of high-risk vascular patients.
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Affiliation(s)
- Myriam Amsallem
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France.
| | - Stephane Manzo-Silberman
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Georgios Sideris
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Sebastian Voicu
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Claire Bal dit Sollier
- Department of Angio-Hematology and IVS-Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Ludovic Drouet
- Department of Angio-Hematology and IVS-Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
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Bonten TN, Snoep JD, Assendelft WJ, Zwaginga JJ, Eikenboom J, Huisman MV, Rosendaal FR, van der Bom JG. Time-Dependent Effects of Aspirin on Blood Pressure and Morning Platelet Reactivity. Hypertension 2015; 65:743-50. [DOI: 10.1161/hypertensionaha.114.04980] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aspirin is used for cardiovascular disease (CVD) prevention by millions of patients on a daily basis. Previous studies suggested that aspirin intake at bedtime reduces blood pressure compared with intake on awakening. This has never been studied in patients with CVD. Moreover, platelet reactivity and CVD incidence is highest during morning hours. Bedtime aspirin intake may attenuate morning platelet reactivity. This clinical trial examined the effect of bedtime aspirin intake compared with intake on awakening on 24-hour ambulatory blood pressure measurement and morning platelet reactivity in patients using aspirin for CVD prevention. In this randomized open-label crossover trial, 290 patients were randomized to take 100 mg aspirin on awakening or at bedtime during 2 periods of 3 months. At the end of each period, 24-hour blood pressure and morning platelet reactivity were measured. The primary analysis population comprised 263 (blood pressure) and 133 (platelet reactivity) patients. Aspirin intake at bedtime did not reduce blood pressure compared with intake on awakening (difference systolic/diastolic: −0.1 [95% confidence interval, −1.0, 0.9]/−0.6 [95% confidence interval, −1.2, 0.0] mm Hg). Platelet reactivity during morning hours was reduced with bedtime aspirin intake (difference: −22 aspirin reaction units [95% confidence interval, −35, −9]). The intake of low-dose aspirin at bedtime compared with intake on awakening did not reduce blood pressure of patients with CVD. However, bedtime aspirin reduced morning platelet reactivity. Future studies are needed to assess the effect of this promising simple intervention on the excess of cardiovascular events during the high risk morning hours.
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Affiliation(s)
- Tobias N. Bonten
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Jaapjan D. Snoep
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Willem J.J. Assendelft
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Jaap Jan Zwaginga
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Jeroen Eikenboom
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Menno V. Huisman
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Frits R. Rosendaal
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
| | - Johanna G. van der Bom
- From the Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (T.N.B., J.D.S., F.R.R., J.G.v.d.B.); Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands (W.J.J.A.); Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands (W.J.J.A.); JJ van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands (J.J.Z., J.G.v.d.B.); and
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Gong Y, Lin M, Piao L, Li X, Yang F, Zhang J, Xiao B, Zhang Q, Song WL, Yin H, Zhu L, Funk CD, Yu Y. Aspirin enhances protective effect of fish oil against thrombosis and injury-induced vascular remodelling. Br J Pharmacol 2015; 172:5647-60. [PMID: 25339093 DOI: 10.1111/bph.12986] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/15/2014] [Accepted: 10/16/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Although aspirin (acetylsalicylic acid) is commonly used to prevent ischaemic events in patients with coronary artery disease, many patients fail to respond to aspirin treatment. Dietary fish oil (FO), containing ω3 polyunsaturated fatty acids (PUFAs), has anti-inflammatory and cardio-protective properties, such as lowering cholesterol and modulating platelet activity. The objective of the present study was to investigate the potential additional effects of aspirin and FO on platelet activity and vascular response to injury. EXPERIMENTAL APPROACH Femoral arterial remodelling was induced by wire injury in mice. Platelet aggregation, and photochemical- and ferric chloride-induced carotid artery thrombosis were employed to evaluate platelet function. KEY RESULTS FO treatment increased membrane ω3 PUFA incorporation, lowered plasma triglyceride and cholesterol levels, and reduced systolic BP in mice. FO or aspirin alone inhibited platelet aggregation; however, when combined, they exhibited synergistic suppression of platelet activity in mice, independent of COX-1 inhibition. FO alone, but not aspirin, attenuated arterial neointimal growth in response to injury. Strikingly, a combination of FO and aspirin synergistically inhibited injury-induced neointimal hyperplasia and reduced perivascular inflammatory reactions. Moreover, co-administration of FO and aspirin decreased the expression of pro-inflammatory cytokines and adhesion molecules in inflammatory cells. Consistently, a pro-resolution lipid mediator-Resolvin E1, was significantly elevated in plasma in FO/aspirin-treated mice. CONCLUSIONS AND IMPLICATIONS Co-administration of FO and low-dose aspirin may act synergistically to protect against thrombosis and injury-induced vascular remodelling in mice. Our results support further investigation of adjuvant FO supplementation for patients with stable coronary artery disease.
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Affiliation(s)
- Yanjun Gong
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Minghui Lin
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Lingjuan Piao
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Xinzhi Li
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Fei Yang
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Jian Zhang
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Bing Xiao
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Qingli Zhang
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Wen-Liang Song
- Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT, USA
| | - Huiyong Yin
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
| | - Li Zhu
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, The First Affiliated Hospital, Soochow University, Suzhou, China
| | - Colin D Funk
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Ying Yu
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of the Chinese Academy of Sciences, Shanghai, China
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59
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Patrono C. Role of Clinical Pharmacology in the Development of Antiplatelet Drugs. Clin Ther 2014; 36:2096-2111. [DOI: 10.1016/j.clinthera.2014.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/15/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Kaplon-Cieslicka A, Postula M, Rosiak M, Peller M, Kondracka A, Serafin A, Trzepla E, Opolski G, Filipiak KJ. Younger age, higher body mass index and lower adiponectin concentration predict higher serum thromboxane B2 level in aspirin-treated patients with type 2 diabetes: an observational study. Cardiovasc Diabetol 2014; 13:112. [PMID: 25123549 PMCID: PMC4149275 DOI: 10.1186/s12933-014-0112-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/08/2014] [Indexed: 12/25/2022] Open
Abstract
Background Evidence from the literature suggests diminished acetylsalicylic acid (ASA) treatment efficacy in type 2 diabetes (DM2). High on-aspirin platelet reactivity (HAPR) in DM2 has been linked to poor glycemic and lipid control. However, there are no consistent data on the association between HAPR and insulin resistance or adipose tissue metabolic activity. The aim of this study was to assess the relationship between laboratory response to ASA and metabolic control, insulin resistance and adipokines in DM2. Methods A total of 186 DM2 patients treated with oral antidiabetic drugs and receiving 75 mg ASA daily were included in the analysis. Response to ASA was assessed by measuring serum thromboxane B2 (TXB2) concentration and expressed as quartiles of TXB2 level. The achievement of treatment targets in terms of glycemic and lipid control, insulin resistance parameters (including Homeostatic Model Assessment-Insulin Resistance, HOMA-IR, index), and serum concentrations of high-molecular weight (HMW) adiponectin, leptin and resistin, were evaluated in all patients. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors of serum TXB2 concentration above the upper quartile and above the median. Results Significant trends in age, body mass index (BMI), HOMA-IR, HMW adiponectin concentration, C-reactive protein concentration and the frequency of achieving target triglyceride levels were observed across increasing quartiles of TXB2. In a multivariate analysis, only younger age and higher BMI were independent predictors of TXB2 concentration above the upper quartile, while younger age and lower HMW adiponectin concentration were predictors of TXB2 concentration above the median. Conclusions These results suggest that in DM2, the most important predictor of HAPR is younger age. Younger DM2 patients may therefore require total daily ASA doses higher than 75 mg, preferably as a twice-daily regimen, to achieve full therapeutic effect. Higher BMI and lower HMW adiponectin concentration were also associated with less potent ASA effect. This is the first study to demonstrate an association of lower adiponectin concentration with higher serum TXB2 level in patients treated with ASA.
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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62
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Christensen KH, Grove EL, Würtz M, Kristensen SD, Hvas AM. Reduced antiplatelet effect of aspirin during 24 hours in patients with coronary artery disease and type 2 diabetes. Platelets 2014; 26:230-5. [DOI: 10.3109/09537104.2014.901497] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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63
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Faye E, Drouet L, De Raucourt E, Green A, Bal-dit-Sollier C, Boudaoud L, Corcos O, Bergmann JF, Joly F, Lloret-Linares C. Absorption and Efficacy of Acetylsalicylic Acid in Patients With Short Bowel Syndrome. Ann Pharmacother 2014; 48:705-10. [DOI: 10.1177/1060028014526700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: The patients with a short bowel (SB) frequently require antiplatelet therapy. Resection of the bowel is likely to modify the absorption and first-pass effect of drugs. No data on the absorption and efficacy of the cardiovascular dose of aspirin (75-160 mg) in these patients have been published. Objective: To evaluate the efficacy of a low dose of aspirin in patients with SB caused by mesenteric ischemia. Methods: The efficacy of a low dose of aspirin was assessed in 10 consecutive SB patients, both 1 hour and 24 hours after administration (peak and trough value, respectively). The primary criterion was the inhibition of platelet aggregation, as assessed by light transmission aggregometry, triggered with 0.5 mg/mL arachidonic acid. Biological efficacy of aspirin was also evaluated by serum thromboxane B2 value and by platelet function analyzer-100. Results: At its peak value, aspirin had the expected efficacy, as demonstrated both by light transmission aggregometry and the other methods. However, 24 hours after administration, as many as 30% of patients had lost the pharmacological efficacy of their aspirin. Conclusion: We show for the first time that with at least 30 cm of small intestine, all patients with SB absorb sufficient oral aspirin in a cardiovascular dose to rapidly exert the expected level of antiplatelet activity. But given only once daily, aspirin does not provide stable 24-hour antiplatelet protection in 30% of patients, because of increased platelet turnover, as usually observed in patients with extensive vascular pathology, diabetes, or inflammation.
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Affiliation(s)
- Elodie Faye
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne A, Hôpital Lariboisière, Paris, France
| | - Ludovic Drouet
- Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France
| | - Emmanuelle De Raucourt
- Assistance Publique-Hôpitaux de Paris, Service d’hématologie biologique, Hôpital Beaujon, Clichy, France
| | | | | | - Larbi Boudaoud
- Assistance Publique-Hôpitaux de Paris, Service d’hématologie biologique, Hôpital Beaujon, Clichy, France
| | - Olivier Corcos
- Assistance Publique-Hôpitaux de Paris, Service de nutrition, Hôpital Beaujon, Clichy, France
| | - Jean-François Bergmann
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne A, Hôpital Lariboisière, Paris, France
| | - Francisca Joly
- Assistance Publique-Hôpitaux de Paris, Service de nutrition, Hôpital Beaujon, Clichy, France
| | - Célia Lloret-Linares
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne A, Hôpital Lariboisière, Paris, France
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64
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Nagelschmitz J, Blunck M, Kraetzschmar J, Ludwig M, Wensing G, Hohlfeld T. Pharmacokinetics and pharmacodynamics of acetylsalicylic acid after intravenous and oral administration to healthy volunteers. Clin Pharmacol 2014; 6:51-9. [PMID: 24672263 PMCID: PMC3964022 DOI: 10.2147/cpaa.s47895] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background The pharmacology of single doses of acetylsalicylic acid (ASA) administered intravenously (250 or 500 mg) or orally (100, 300, or 500 mg) was evaluated in a randomized, placebo-controlled, crossover study. Methods Blood and urine samples were collected before and up to 24 hours after administration of ASA in 22 healthy volunteers. Pharmacokinetic parameters and measurements of platelet aggregation were determined using validated techniques. Results A comparison between administration routes showed that the geometric mean dose-corrected peak concentrations (Cmax/D) and the geometric mean dose-corrected area under the curve (AUC0–∞/D) were higher following intravenous administration of ASA 500 mg compared with oral administration (estimated ratios were 11.23 and 2.03, respectively). Complete inhibition of platelet aggregation was achieved within 5 minutes with both intravenous ASA doses, reflecting a rapid onset of inhibition that was not observed with oral dosing. At 5 minutes after administration, the mean reduction in arachidonic acid-induced thromboxane B2 synthesis ex vivo was 99.3% with ASA 250 mg intravenously and 99.7% with ASA 500 mg intravenously. In exploratory analyses, thromboxane B2 synthesis was significantly lower after intravenous versus oral ASA 500 mg (P<0.0001) at each observed time point up to the first hour after administration. Concentrations of 6-keto-prostaglandin1α at 5 and 20 minutes after dosing were also significantly lower with ASA 500 mg intravenously than with ASA 500 mg orally. Conclusion This study demonstrates that intravenous ASA provides more rapid and consistent platelet inhibition than oral ASA within the first hour after dosing.
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Affiliation(s)
- J Nagelschmitz
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Blunck
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany
| | - J Kraetzschmar
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany
| | - M Ludwig
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany
| | - G Wensing
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany
| | - T Hohlfeld
- Institut für Pharmakologie und Klinische Pharmakologie, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Germany
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DiNicolantonio JJ, Norgard NB, Meier P, Lavie CJ, O’Keefe J, Niazi AK, Chatterjee S, Packard KA, D’Ascenzo F, Cerrato E, Biondi-Zoccai G, Bangalore S, Fuchs FD, Serebruany VL. Optimal aspirin dose in acute coronary syndromes: an emerging consensus. Future Cardiol 2014; 10:291-300. [PMID: 24762255 DOI: 10.2217/fca.14.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
ABSTRACT: Numerous clinical trials testing the efficacy of aspirin for the secondary prevention of cardiovascular disease have been published. We reviewed the literature pertaining to aspirin dose in acute coronary syndrome patients. Clinical trials assessing the comparative efficacy of different doses of aspirin are scarce. This complex antiplatelet therapy landscape makes it difficult to identify the best aspirin dose for optimizing efficacy and minimizing risk of adverse events, while complying with the various guidelines and recommendations. Despite this fact, current evidence suggests that aspirin doses of 75–100 mg/day may offer the optimal benefit:risk ratio in acute coronary syndrome patients.
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Affiliation(s)
| | - Nicholas B Norgard
- University of Buffalo, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY, USA
| | - Pascal Meier
- The Heart Hospital, University College London Hospitals, London, UK
- Yale Medical School, New Haven, CT, USA
| | - Carl J Lavie
- John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
- The Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - James H O’Keefe
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri, Kansas City, Kansas City, MO, USA
| | | | - Saurav Chatterjee
- St Luke’s Roosevelt Hospital Center, Division of Cardiology, New York, NY, USA
| | - Kathleen A Packard
- Creighton University, School of Pharmacy & Health Professions, Omaha, NE, USA
| | - Fabrizio D’Ascenzo
- University of Turin, Division of Cardiology, Citta Della Salute e Della Scienza, Torino, Italy
| | - Enrico Cerrato
- University of Turin, Division of Cardiology, Citta Della Salute e Della Scienza, Torino, Italy
| | - Giuseppe Biondi-Zoccai
- Sapienza University of Rome, Department of Medico-Surgical Sciences & Biotechnologies, Latina, Italy
| | | | - Flavio D Fuchs
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Division of Cardiology & Postgraduate Studies Program in Cardiology, Rio Grande do Sul, Brazil
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66
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Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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67
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DILLINGER JEANGUILLAUME, SIDERIS GEORGIOS, KCHAOU IHEB, BAL DIT SOLLIER CLAIRE, MANZO SILBERMAN STEPHANE, VOICU SEBASTIAN, MAGKOUTIS NIKOLAOS, LOGEART DAMIEN, DROUET LUDOVIC, HENRY PATRICK. Monitoring Persistent Platelet Reactivity in Patients with Unprotected Left Main Stenting. J Interv Cardiol 2013; 26:578-85. [DOI: 10.1111/joic.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- JEAN-GUILLAUME DILLINGER
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - GEORGIOS SIDERIS
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - IHEB KCHAOU
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - CLAIRE BAL DIT SOLLIER
- Angio-hematology and IVS-Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - STEPHANE MANZO SILBERMAN
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - SEBASTIAN VOICU
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - NIKOLAOS MAGKOUTIS
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - DAMIEN LOGEART
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - LUDOVIC DROUET
- Angio-hematology and IVS-Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
| | - PATRICK HENRY
- Department of Cardiology; Inserm U942, Lariboisiere Hospital, AP-HP-Paris Diderot University; Paris France
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013; 34:3035-87. [PMID: 23996285 DOI: 10.1093/eurheartj/eht108] [Citation(s) in RCA: 1394] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Abstract
Aspirin is integral to the secondary prevention of cardiovascular disease and acts to impair the development of platelet-mediated atherothromboembolic events by irreversible inhibition of platelet cyclooxygenase-1 (COX-1). Inhibition of this enzyme prevents the synthesis of the potent pro-aggregatory prostanoid thromboxane A2. A large number of patients continue to experience atherothromboembolic events despite aspirin therapy, so-called 'aspirin treatment failure', and this is multifactorial in aetiology. Approximately 10% however do not respond appropriately to aspirin in a phenomenon known as 'aspirin resistance', which is defined by various laboratory techniques. In this review we discuss the reasons for aspirin resistance in a systematic manner, starting from prescription of the drug and ending at the level of the platelet. Poor medication adherence has been shown to be a cause of apparent aspirin resistance, and may in fact be the largest contributory factor. Also important is high platelet turnover due to underlying inflammatory processes, such as atherosclerosis and its complications, leading to faster regeneration of platelets, and hence of COX-1, at a rate that diminishes the efficacy of once daily dosing. Recent developments include the identification of platelet glycoprotein IIIa as a potential biomarker (as well as possible underlying mechanism) for aspirin resistance and the discovery of an anion efflux pump that expels intracellular aspirin from platelets. The absolute as well as relative contributions of such factors to the phenomenon of aspirin resistance are the subject of continuing research.
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Affiliation(s)
- Christopher N Floyd
- Department of Clinical Pharmacology, Cardiovascular Division, King's College London, London, UK
| | - Albert Ferro
- Department of Clinical Pharmacology, Cardiovascular Division, King's College London, London, UK.
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Aspirin Dose Increase from 75 to 150 mg Suppresses Red Blood Cell Contribution to Suboptimal Platelet Response to Aspirin in Patients with CAD. Cardiovasc Drugs Ther 2013; 27:549-58. [DOI: 10.1007/s10557-013-6480-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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