The paradoxical thrombogenic effect of aspirin in experimental thrombosis

The effect of aspirin on recurrent fetal loss in experimental antiphospholipid syndrome

PURPOSE

To evaluate the effect of aspirin treatment upon fetal loss in mice with experimental antiphospholipid syndrome (APLS).

MATERIALS AND METHODS

Experimental APLS was induced in pregnant mice by passive transfer of mouse monoclonal anticardiolipin antibody. The mice were treated with high (100 micrograms/d) or low (10 micrograms/d) dose of aspirin, using vitamin C (100 micrograms/d or 10 micrograms/d) as a control. The mice were assessed for the presence of lupus anticoagulants (prolonged aPTT), thrombocytopenia, degree of fetal resorption rate and mean embryo and placental weights.

RESULTS

The mice with APLS had a higher fetal resorption rate (45.7 +/- 12.2% vs 2.5 +/- 0.4%, P < 0.001), reduced placenta mean weight (104 +/- 8 mg vs 169 +/- 7 mg, P < 0.001), prolonged aPTT (94 +/- 14 sec vs 39 +/- 4 sec, P < 0.001), and reduced mean platelet count (597 +/- 186 x 10(3)/mm3 vs 847 +/- 51 x 10(3)/mm3, P < 0.001). The group of mice with APLS, who were treated with low-dose aspirin, had a lower resorption rate (11.1 +/- 9.3% vs 45.7 +/- 12.2%, P < 0.001), a higher placenta mean weight (178 +/- 8 mg vs 104 +/- 8 mg, P < 0.001), a higher mean embryo weight (1042 +/- 134 mg vs 721 +/- 91 mg, P < 0.001), and a lower aPTT (58 +/- 15 sec vs 94 +/- 14 sec, P < 0.001). Mice who were treated with high-dose aspirin also had a lower resorption rate, although not as much as in the low-dose aspirin group (34.2 +/- 12.7% vs 45.7 +/- 12.2%, P < 0.001).

CONCLUSION

Aspirin, especially in low dose, has a protective effect against obstetrical complications associated with experimental APLS.

Cerebral hemorrhagic risk of aspirin or heparin therapy with thrombolytic treatment in rabbits

We studied the incidence of cerebral hemorrhage in an animal model of embolic stroke to determine the safety of aspirin, heparin, and tissue plasminogen activator therapies. We occluded the middle cerebral arteries of rabbits with labeled blood clots and administered either tissue plasminogen activator, heparin, aspirin, tissue plasminogen activator plus aspirin, tissue plasminogen activator plus heparin, or saline at various times after stroke. Compared to saline controls, both the aspirin-only and the tissue plasminogen activator-plus-aspirin groups had a significantly higher incidence of cerebral hemorrhage, whereas the heparin and tissue plasminogen activator combination groups did not. We conclude that aspirin antiplatelet therapy alone may increase the risk of hemorrhagic infarction, whereas heparin or tissue plasminogen activator therapy appears to be relatively safe.

Effect of a prostaglandin E1 derivative (OP-1206) and acetylsalicylic acid on electrically induced thrombosis in guinea-pig mesenteric artery and its modification by an inhibitor of prostaglandin I2 synthetase, tranylcypromine

The antithrombotic effect of a prostaglandin E1 derivative, OP-1206 (17S-20-dimethyl-trans-delta 2-PGE1) X alpha-cyclodextrin clathrate (OP-1206 X alpha-CD), was compared with that of acetylsalicylic acid (ASA) in a electrically induced thrombosis model of guinea-pig mesenteric arteries using intact animals and animals subjected to the superfusion of tranylcypromine (TC, 15 mM) over their mesentery. The drug-effect was assessed by the change of the threshold voltage for the thrombus formation. 1) TC (1.5-15 mM) lowered the threshold voltage, and the effect was comparable to its inhibitory effect on PGI2 formation in vitro, suggesting that PGI2 generated in mesenteric arteries acts to prevent thrombus formation. 2) In intact animals, OP-1206 X alpha-CD at doses of 0.01-0.3 mg/kg, p.o. (as OP-1206), significantly and dose-dependently elevated the threshold voltage. ASA (30-1000 mg/kg, p.o.) significantly elevated the threshold voltage, but the effect reached to its maximum at 100 mg/kg and lessened with further increase of ASA. 3) In TC-treated animals, OP-1206 X alpha-CD elevated the threshold voltage dose-dependently, but the elevation of threshold voltage by ASA reached to its plateau level which was significantly lower than that obtained with OP-1206 X alpha-CD at 0.3 mg/kg, indicating that the antithrombotic effect of ASA is incomplete in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

Aspirin inhibits vascular plasminogen activator activity in vivo. Studies utilizing a new assay to quantify plasminogen activator activity

Vascular or tissue-type plasminogen activator (TPA) is a key enzyme in physiologic fibrinolysis. To study the role of prostaglandins in modulating the synthesis and release of TPA in vivo, we prospectively studied the effect of aspirin (650 mg/d X 2) on TPA activity in 13 human subjects before and after 10 min of forearm venous occlusion. TPA activity was quantified by a newly developed enzyme-linked immunosorbent assay that both measures and differentiates between TPA and urokinase (UK)-like plasminogen activator activity. This assay is based on the observation that the concentration of alpha 2-plasmin inhibitor-plasmin complexes in Reptilase-clotted plasma increases linearly in proportion to the amount of activator added. Resting TPA activity was higher in women than in men (0.56 +/- 0.59 vs. 0.15 +/- 0.11 U/ml, P = 0.049). Venous occlusion induced an eightfold rise in TPA activity in women (to 4.5 U/ml, P = 0.006) and a 15-fold rise in men (to 2.28 U/ml, P = 0.004), whereas UK activity was not detected. Aspirin inhibited the rise in TPA activity after venous occlusion by 69% in men (P = 0.004) and 70% in women (P = 0.014). In contrast, aspirin had no effect on pre- or post-occlusion hematocrits or Factor VIII-related antigen levels. There was no correlation between plasma salicylate level and percentage inhibition of TPA. Neither exogenous aspirin (0-1 microgram/ml) nor salicylate (0-70 micrograms/ml) inhibited the generation of alpha 2-plasmin inhibitor-plasmin complexes by exogenous TPA or interfered with the assay system. We conclude that aspirin may have an antifibrinolytic effect in man that has not been previously described.

Effects of aspirin dosage and time of administration on arterial prostacyclin production and platelet aggregation in rats

Previously we reported that electrically-induced carotid artery thrombosis in anesthetized rats was prevented by 3.3 or 10 mg/kg aspirin (ASA) given i.v. 10 min before injury but not by 1.7, 20 or 100 mg/kg and protection was lost by delaying injury to 20 min (Haemostasis 13:42, 1983). Here, collagen-induced platelet aggregation and arterial prostacyclin-generating activity, measured by RIA for 6 keto-PGF1 alpha and by human platelet aggregation bioassay, were studied ex vivo after i.v. ASA to anesthetized rats. In all cases where platelet aggregation was inhibited less than 50%, no protection had been observed (1.7 mg/kg at 10 min, 3.3 at 20 min, 20 at 10 min). In the two cases where protection had been observed, platelet aggregation was inhibited by about 75% or more and in one, prostacyclin activity was about 50% of normal (3.3 mg/kg at 10 min). Thus in five of six dose-time combinations tested, antithrombotic protection could be explained by a requirement for about 50% of normal prostacyclin activity and about 75% of inhibition of collagen aggregation. Aberrant findings are discussed in the light of knowledge of salicylate/aspirin competition for cyclooxygenase.

[Effects of acetylsalicylic acid on partial functions of human thrombocytes are not inhibited in vivo by salicylic acid]

Acetylsalicylic acid inhibits platelet function. In plasma acetylsalicylic acid is rapidly deacetylated to salicylic acid which is slowly eliminated and has no direct inhibitory effects on platelet function. However, salicylic acid prevents the inhibition by acetylsalicylic acid of collagen-induced aggregation of human thrombocytes in vitro. It was suggested that salicylic acid might inhibit the antiplatelet effects of acetylsalicylic acid in vivo and therefore low-dose acetylsalicylic acid would be more effective for antithrombotic therapy. A 500-mg tablet of acetylsalicylic acid applied 90 min after oral administration of 500 mg salicylic acid to six healthy male volunteers led to the same inhibition of collagen-induced platelet aggregation and tissue-extract-induced platelet stimulation as 500 mg acetylsalicylic acid alone. These results cannot give additional support to the recommendation of low-dose acetylsalicylic acid in the prevention of thromboembolic disease.

Anti-thrombotic effect of very low doses of acetyl salicylic acid in rats

The anti-thrombotic effect of acetyl salicylic acid (ASA) was studied using the following experimental model: a silk thread was inserted in an extracorporeal shunt between the right carotid artery and the opposite jugular vein. A thrombus developed around the thread which was weighed at 10 minutes intervals. ASA inhibits the development of the thrombus at a dose of 3.1 mg/kg. When the dose was increased the anti-thrombotic effect disappeared. These results suggest that ASA may be an effective antithrombotic agent in man if the dosage is based on pharmacological data.