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Seecheran N, McCallum P, Grimaldos K, Ramcharan P, Kawall J, Katwaroo A, Seecheran V, Jagdeo CL, Rafeeq S, Seecheran R, Quert AL, Ali N, Peram L, Khan S, Ali F, Motilal S, Bhagwandass N, Giddings S, Ramlackhansingh A, Sandy S. Pharmacodynamic Comparison of Two Aspirin Formulations in the Caribbean: The ARC Study. Cardiol Ther 2024; 13:593-602. [PMID: 39008026 PMCID: PMC11333668 DOI: 10.1007/s40119-024-00373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION This prospective, single-arm, crossover pharmacodynamic study assessed the effect of Bayer® low-dose enteric-coated aspirin 81 mg tablets (LD EC-ASA) (Bayer AG, Leverkusen, North Rhine-Westphalia, Germany) compared to Vazalore® low-dose phospholipid-aspirin liquid-filled 81 mg capsules (LD PL-ASA) (PLx Pharma Inc., Sparta, NJ, USA) on platelet reactivity with respect to aspirin reaction units (ARU). METHODS Forty-seven healthy volunteers were recruited. Platelet function was evaluated with the VerifyNow™ ARU assay (Werfen, Bedford, MA, USA) and assessed post-initiation of Bayer® LD EC-ASA daily for 14 days, with a washout period of 28 days, followed by Vazalore® LD PL-ASA daily for 14 days, again followed by ARU testing. RESULTS Participants on LD EC-ASA had a mean ARU score of 426, with 19.1% of participants having an ARU > 550; patients on LD PL-ASA derived a mean ARU score of 435, with 14.9% achieving an ARU > 550. There were no significant differences in aspirin resistance (ARU > 550) according to the formulation (Bayer® LD EC-ASA vs. Vazalore® LD PL-ASA) used. Aspirin resistance was independent of ethnicity regardless of the formulation used. In addition, there were no significant associations between body surface area (BSA) and Bayer® LD EC-ASA ARU value (p value 0.788) or Vazalore® LD PL-ASA ARU value (p value 0.477). No patients experienced any serious adverse events or treatment-emergent adverse events. CONCLUSIONS There were no significant differences in aspirin resistance between Bayer® LD EC-ASA and Vazalore® LD PL-ASA. This dedicated pharmacodynamic study could potentially be informative and applicable for Trinidadian patients on dual antiplatelet therapy (DAPT). Further studies are required to confirm these exploratory findings. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT06228820, prospectively registered 1/18/2024.
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Affiliation(s)
- Naveen Seecheran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago.
| | - Penelope McCallum
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Kathryn Grimaldos
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Priya Ramcharan
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Jessica Kawall
- Department of Medicine, Trinidad Institute of Medical Technology, St. Augustine, Trinidad and Tobago
| | - Arun Katwaroo
- Department of Medicine, Trinidad Institute of Medical Technology, St. Augustine, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Cathy-Lee Jagdeo
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Salma Rafeeq
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, Kansas University Medical Center, Wichita, KS, USA
| | - Abel Leyva Quert
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Nafeesah Ali
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Lakshmipathi Peram
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Shari Khan
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Fareed Ali
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Neal Bhagwandass
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Stanley Giddings
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Anil Ramlackhansingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Sherry Sandy
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
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Kato M, Ito H, Yamakawa A, Kagimura T, Fukagawa M, Yamamoto M, Saito Y, Akizawa T, Ogata H. Effect of aspirin on cardiovascular events in patients undergoing hemodialysis with hyperphosphatemia: A post hoc analysis of the LANDMARK trial. Ther Apher Dial 2024; 28:580-590. [PMID: 38471797 DOI: 10.1111/1744-9987.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The clinical benefits of aspirin in patients undergoing hemodialysis remain unclear. METHODS The secondary analysis of the LANDMARK trial investigated whether aspirin use was associated with cardiovascular events (CVEs) and all-cause mortality was performed. A total of 2135 patients at risk for vascular calcification were analyzed using a Cox proportional hazards model with propensity score matching. RESULTS The risk of CVEs was comparable between participants with aspirin use at baseline and those without at baseline, between participants with aspirin use during the study period and those without during the study period, and between participants with new aspirin prescription and those without aspirin use during the study period. CONCLUSION Aspirin use was not significantly associated with a lower risk of CVEs in participants undergoing hemodialysis patients at risk of vascular calcification.
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Affiliation(s)
- Masanori Kato
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Hidetoshi Ito
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Akane Yamakawa
- The Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | - Tatsuo Kagimura
- The Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Kobe, Hyogo, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiro Yamamoto
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Yoshinori Saito
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University Graduate School of Medicine, Shinagawa, Tokyo, Japan
| | - Hiroaki Ogata
- Division of Nephrology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Medical Education, Showa University Graduate School of Medicine, Shinagawa, Tokyo, Japan
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Nikitina LE, Bocharov PS, Ksenofontov AA, Antina EV, Gilfanov IR, Pavelyev RS, Ostolopovskaya OV, Fedyunina IV, Azizova ZR, Pestova SV, Izmest’ev ES, Rubtsova SA, Boichuk SV, Galembikova AR, Smolyarchuk EA, Mustafin IG, Kayumov AR, Samorodov AV. Unraveling the Mechanism of Platelet Aggregation Suppression by Thioterpenoids: Molecular Docking and In Vivo Antiaggregant Activity. Biomimetics (Basel) 2023; 8:570. [PMID: 38132509 PMCID: PMC10742178 DOI: 10.3390/biomimetics8080570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Natural monoterpenes and their derivatives are widely considered the effective ingredients for the design and production of novel biologically active compounds. In this study, by using the molecular docking technique, we examined the effects of two series of "sulfide-sulfoxide-sulfone" thioterpenoids containing different (e.g., bornane and pinane) monoterpene skeletons on the platelet's aggregation. Our data revealed that all the synthesized compounds exhibit inhibitory activities on platelet aggregation. For example, compound 1 effectively inhibited platelet activation and demonstrated direct binding with CD61 integrin, a well-known platelet GPIIb-IIIa receptor on platelets. We further examined the antiaggregant activity of the most active compound, 1, in vivo and compared its activity with that of acetylsalicylic acid and an oral GPIIb-IIIa blocker, orbofiban. We found that compound 1 demonstrates antiaggregant activity in rats when administered per os and its activity was comparable with that of acetylsalicylic acid and orbofiban. Moreover, similarly, tirofiban, a well-known GPIIb-IIIa blocker, compound 1, effectively decreased the expression of P-selectin to the values similar to those of the intact platelets. Collectively, here, we show, for the first time, the potent antiaggregant activity of compound 1 both in vitro and in vivo due to its ability to bind with the GPIIb-IIIa receptor on platelets.
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Affiliation(s)
- Liliya E. Nikitina
- General and Organic Chemistry Department, Kazan State Medical University, 420012 Kazan, Russia; (O.V.O.); (I.V.F.); (Z.R.A.)
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
| | - Pavel S. Bocharov
- G.A. Krestov Institute of Solution Chemistry of the Russian Academy of Sciences, 153045 Ivanovo, Russia; (P.S.B.); (A.A.K.); (E.V.A.)
| | - Alexander A. Ksenofontov
- G.A. Krestov Institute of Solution Chemistry of the Russian Academy of Sciences, 153045 Ivanovo, Russia; (P.S.B.); (A.A.K.); (E.V.A.)
- Department of Inorganic Chemistry, Ivanovo State University of Chemistry and Technology, 153045 Ivanovo, Russia
| | - Elena V. Antina
- G.A. Krestov Institute of Solution Chemistry of the Russian Academy of Sciences, 153045 Ivanovo, Russia; (P.S.B.); (A.A.K.); (E.V.A.)
| | - Ilmir R. Gilfanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
- Varnishes and Paints Coatings Department, Kazan National Research Technological University, 420015 Kazan, Russia
| | - Roman S. Pavelyev
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
| | - Olga V. Ostolopovskaya
- General and Organic Chemistry Department, Kazan State Medical University, 420012 Kazan, Russia; (O.V.O.); (I.V.F.); (Z.R.A.)
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
| | - Inna V. Fedyunina
- General and Organic Chemistry Department, Kazan State Medical University, 420012 Kazan, Russia; (O.V.O.); (I.V.F.); (Z.R.A.)
| | - Zulfiya R. Azizova
- General and Organic Chemistry Department, Kazan State Medical University, 420012 Kazan, Russia; (O.V.O.); (I.V.F.); (Z.R.A.)
| | - Svetlana V. Pestova
- Medical Chemistry Laboratory, Institute of Chemistry, Komi Scientific Centre, Ural Branch of Russian Academy of Sciences, 167000 Syktyvkar, Russia; (S.V.P.); (E.S.I.); (S.A.R.)
| | - Evgeniy S. Izmest’ev
- Medical Chemistry Laboratory, Institute of Chemistry, Komi Scientific Centre, Ural Branch of Russian Academy of Sciences, 167000 Syktyvkar, Russia; (S.V.P.); (E.S.I.); (S.A.R.)
| | - Svetlana A. Rubtsova
- Medical Chemistry Laboratory, Institute of Chemistry, Komi Scientific Centre, Ural Branch of Russian Academy of Sciences, 167000 Syktyvkar, Russia; (S.V.P.); (E.S.I.); (S.A.R.)
| | - Sergei V. Boichuk
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
- Department of Pathology, Kazan State Medical University, 420012 Kazan, Russia;
- Department of Radiotherapy and Radiology, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
| | | | - Elena A. Smolyarchuk
- Department of Pharmacology, Sechenov First Moscow State Medical University (Sechenov University), 125993 Moscow, Russia;
| | - Ilshat G. Mustafin
- Biochemistry Department, Kazan State Medical University, 420012 Kazan, Russia;
| | - Airat R. Kayumov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.R.G.); (R.S.P.); (S.V.B.)
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Za P, Papalia GF, Franceschetti E, Rizzello G, Adravanti P, Papalia R. Aspirin is a safe and effective thromboembolic prophylaxis after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:4407-4421. [PMID: 37449989 DOI: 10.1007/s00167-023-07500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Patients undergoing total knee arthroplasty (TKA) are at high risk for thromboembolic events compared to non-surgical patients. Both anticoagulants and antiplatelet agents are used as antithrombotic prophylaxis in TKA. The aim of this review is to understand the role of aspirin in the prevention of thromboembolic events and to compare its efficacy and safety with the main anticoagulants used in antithromboembolic prophylaxis in TKA. METHODS A systematic review and meta-analysis was performed according to the PRISMA guidelines. An electronic systematic search was conducted using PubMed, Scopus, and the Cochrane Central Registry to evaluate studies that compared aspirin with other anticoagulants, in terms of deep venous thrombosis and pulmonary embolism after TKA. The meta-analysis compared the rate of complications between aspirin and other anticoagulants. RESULTS Thirteen studies were included in the systematic review for a total of 163,983 patients, and 10 studies were included in the meta-analysis. The meta-analysis demonstrated no statistically significant differences between aspirin and other anticoagulants in terms of the rate of deep venous thrombosis (OR 0.93, 95% CI 0.81-1.08, p = 0.35) and pulmonary embolism (OR 0.89, 95% CI 0.56-1.41, p = 0.61). CONCLUSION Aspirin is safe, effective, and not inferior to other main anticoagulants in preventing thromboembolic events following TKA.
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Affiliation(s)
- Pierangelo Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Paolo Adravanti
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Unraveling the Mechanism of Platelet Aggregation Suppression by Monoterpenoids. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9010024. [PMID: 35049733 PMCID: PMC8773274 DOI: 10.3390/bioengineering9010024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Platelet aggregation causes various diseases and therefore challenges the development of novel antiaggregatory drugs. In this study, we report the possible mechanism of platelet aggregation suppression by newly synthesized myrtenol-derived monoterpenoids carrying different heteroatoms (sulphur, oxygen, or nitrogen). Despite all tested compounds suppressed the platelet aggregation in vitro, the most significant effect was observed for the S-containing compounds. The molecular docking confirmed the putative interaction of all tested compounds with the platelet’s P2Y12 receptor suggesting that the anti-aggregation properties of monoterpenoids are implemented by blocking the P2Y12 function. The calculated binding force depended on heteroatom in monoterpenoids and significantly decreased with the exchanging of the sulphur atom with oxygen or nitrogen. On the other hand, in NMR studies on dodecyl phosphocholine (DPC) as a membrane model, only S-containing compound was found to be bound with DPC micelles surface. Meanwhile, no stable complexes between DPC micelles with either O- or N-containing compounds were observed. The binding of S-containing compound with cellular membrane reinforces the mechanical properties of the latter, thereby preventing its destabilization and subsequent clot formation on the phospholipid surface. Taken together, our data demonstrate that S-containing myrtenol-derived monoterpenoid suppresses the platelet aggregation in vitro via both membrane stabilization and blocking the P2Y12 receptor and, thus, appears as a promising agent for hemostasis control.
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Ferreira M, Freitas-Silva M, Assis J, Pinto R, Nunes JP, Medeiros R. The emergent phenomenon of aspirin resistance: insights from genetic association studies. Pharmacogenomics 2020; 21:125-140. [PMID: 31957546 DOI: 10.2217/pgs-2019-0133] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Despite the clinical benefits of aspirin, the interindividual variation in response to this antiplatelet drug is considerable. The manifestation of aspirin resistance (AR) is frequently observed, although this complex process remains poorly understood. While AR etiology is likely to be multifactorial, genetic factors appear to be preponderant. According to several genetic association studies, both genome-wide and candidate gene studies, numerous SNPs in cyclooxygenase, thromboxane and platelet receptors-related genes have been identified as capable of negatively affecting aspirin action. Thus, it is essential to understand the clinical relevance of AR-related SNPs as potential predictive and prognostic biomarkers as they may be essential to defining the AR phenotype.
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Affiliation(s)
- Márcia Ferreira
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios, 4º piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal.,ICBAS, Abel Salazar Institute for the Biomedical Sciences, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Margarida Freitas-Silva
- FMUP, Faculty of Medicine, Porto University, & Department of Medicine, Centro Hospitalar São João, Porto, Portugal, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Joana Assis
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios, 4º piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal.,FMUP, Faculty of Medicine, Porto University, & Department of Medicine, Centro Hospitalar São João, Porto, Portugal, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Pinto
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios, 4º piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal
| | - José P Nunes
- FMUP, Faculty of Medicine, Porto University, & Department of Medicine, Centro Hospitalar São João, Porto, Portugal, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group-Research Center, Portuguese Institute of Oncology, Edifício Laboratórios, 4º piso, Rua Dr António Bernardino de Almeida, 4200-4072 Porto, Portugal.,FMUP, Faculty of Medicine, Porto University, & Department of Medicine, Centro Hospitalar São João, Porto, Portugal, Alameda Prof Hernâni Monteiro, 4200-319 Porto, Portugal.,Biomedical Research Center, Faculty of Health Sciences, Fernando Pessoa University, Praça 9 de Abril, 349, 4249-004 Porto, Portugal.,Department of Research, Portuguese League Against Cancer (NRNorte), Estrada Interior da Circunvalação, 6657, 4200-172 Porto, Portugal
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Ball STE, Taylor R, McCollum CN. Resistance to Antiplatelet Therapy Is Associated With Symptoms of Cerebral Ischemia in Carotid Artery Disease. Vasc Endovascular Surg 2020; 54:712-717. [PMID: 32856558 PMCID: PMC7555613 DOI: 10.1177/1538574420947235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Platelet inhibitory therapy is prescribed to prevent arterial thromboembolism in patients with atherosclerotic disease. Although taken by millions of people, around 30% are resistant to the treatment they are being prescribed. Aims: To determine whether symptoms of cerebral ischemia, or pre-operative cerebral emboli, in patients admitted for a carotid endarterectomy were associated with resistance to aspirin or clopidogrel. Methods: Venous blood from 133 patients immediately before carotid endarterectomy (CEA) was analyzed for resistance to aspirin and clopidogrel by multiplate impedance aggregometry. The number of emboli/hour entering the ipsilateral middle cerebral artery was counted by transcranial Doppler (TCD) on the day before surgery in 33 of these patients. Results: Resistance was found in 21 (26.3%) of 100 patients taking aspirin and 14 (42%) of 33 taking clopidogrel. Mean (sd) residual platelet aggregation was significantly higher at 41.9(32) Au in patients who had suffered recent symptoms of cerebral ischemia compared with 30.8(16) Au in asymptomatic patients (p = 0.012). Residual platelet aggregation also correlated significantly with the number of emboli/hour counted by TCD in the ipsilateral middle cerebral artery (r = 0.45, p = 0.009). Conclusion: Antiplatelet resistance was associated with the frequency of cerebral emboli and recent symptoms of cerebral ischemia in patients with carotid disease. Definitive clinical studies are needed to explore whether testing for antiplatelet resistance should be undertaken routinely in patients starting platelet inhibitory therapy for cardiovascular disease.
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Affiliation(s)
- Stephen T E Ball
- Academic Surgery Unit, Institute of Cardiovascular Sciences, 5292University of Manchester, Manchester, United Kingdom
| | - Rachael Taylor
- Academic Surgery Unit, Institute of Cardiovascular Sciences, 5292University of Manchester, Manchester, United Kingdom
| | - Charles N McCollum
- Academic Surgery Unit, Institute of Cardiovascular Sciences, 5292University of Manchester, Manchester, United Kingdom
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Barale C, Cavalot F, Frascaroli C, Bonomo K, Morotti A, Guerrasio A, Russo I. Association between High On-Aspirin Platelet Reactivity and Reduced Superoxide Dismutase Activity in Patients Affected by Type 2 Diabetes Mellitus or Primary Hypercholesterolemia. Int J Mol Sci 2020; 21:ijms21144983. [PMID: 32679712 PMCID: PMC7404318 DOI: 10.3390/ijms21144983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Platelet hyperactivation is involved in the established prothrombotic condition of metabolic diseases such as Type 2 Diabetes Mellitus (T2DM) and familial hypercholesterolemia (HC), justifying the therapy with aspirin, a suppressor of thromboxane synthesis through the irreversible inhibition of cyclooxygenase-1 (COX-1), to prevent cardiovascular diseases. However, some patients on aspirin show a higher than expected platelet reactivity due, at least in part, to a pro-oxidant milieu. The aim of this study was to investigate platelet reactivity in T2DM (n = 103) or HC (n = 61) patients (aspirin, 100 mg/day) and its correlation with biomarkers of redox function including the superoxide anion scavenger superoxide dismutase (SOD) and the in vivo marker of oxidative stress urinary 8-iso-prostaglandin F2α. As results, in T2DM and HC subjects the prevalence of high on-aspirin platelet reactivity was comparable when both non-COX-1-dependent and COX-1-dependent assays were performed, and platelet reactivity is associated with a lower SOD activity that in a stepwise linear regression appears as the only predictor of platelet reactivity. To conclude, in T2DM and HC, similarly, the impairment of redox equilibrium associated with a decrease of SOD activity could contribute to a suboptimal response to aspirin.
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Affiliation(s)
- Cristina Barale
- Department of Clinical and Biological Sciences of Turin University, 10043 Orbassano, Turin, Italy; (C.B.); (A.M.); (A.G.)
| | - Franco Cavalot
- Metabolic Disease and Diabetes Unit, San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy; (F.C.); (C.F.); (K.B.)
| | - Chiara Frascaroli
- Metabolic Disease and Diabetes Unit, San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy; (F.C.); (C.F.); (K.B.)
| | - Katia Bonomo
- Metabolic Disease and Diabetes Unit, San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy; (F.C.); (C.F.); (K.B.)
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences of Turin University, 10043 Orbassano, Turin, Italy; (C.B.); (A.M.); (A.G.)
| | - Angelo Guerrasio
- Department of Clinical and Biological Sciences of Turin University, 10043 Orbassano, Turin, Italy; (C.B.); (A.M.); (A.G.)
| | - Isabella Russo
- Department of Clinical and Biological Sciences of Turin University, 10043 Orbassano, Turin, Italy; (C.B.); (A.M.); (A.G.)
- Correspondence: ; Tel.: +39-011-9026622; Fax: +39-011-9038639
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Prevalence of aspirin resistance by thromboelastography plus platelet mapping in children with CHD: a single-centre experience. Cardiol Young 2019; 29:24-29. [PMID: 30501653 DOI: 10.1017/s1047951118000021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
RationaleAspirin resistance has been reported in up to 80% of children with cardiovascular defects undergoing surgery. Because of a patient who had embolic stroke while on therapeutic aspirin dose but in whom aspirin resistance was present on his thromboelastography platelet mapping, we chose to obtain thromboelastography platelet mapping on cardiac patients on aspirin to assess their risk. OBJECTIVES: This study evaluates aspirin resistance noted in these patients and their characteristics.Methods and resultsThis is a retrospective study of 25 patients taking aspirin for a month at therapeutic dose. In total, 11 female patients were enrolled. Ages in all subjects were 5 months to 27 years. A total of 19 patients had a Fontan surgery. Three had a cavopulomanary anastomosis, one had a hybrid procedure, and two had coronary anomalies. Compliance was assessed at the time of the clinic visit. Aspirin resistance was defined as platelet inhibition below 50%. Variables evaluated were level of platelet inhibition, age, body mass index, and gender.
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10
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Girolami A, Cosi E, Ferrari S, Girolami B. Heparin, coumarin, protein C, antithrombin, fibrinolysis and other clotting related resistances: old and new concepts in blood coagulation. J Thromb Thrombolysis 2018; 45:135-141. [PMID: 29063359 DOI: 10.1007/s11239-017-1559-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The concept of resistance in blood coagulation has become important. In the past it was limited to the resistance shown by some patients to heparin, coumarin or aspirin. Subsequently, it was demonstrated that a mutation in a single clotting factor, FV, showed resistance to activated protein C. Since activated protein C is supposed to downregulate aFV and aFVIII, their persistence in the circulation gives origin to a hypercoagulable state. Recently antithrombin resistance has been defined. Several prothrombin abnormalities (dysprothrombinemias) have been shown to be resistant to the action of antithrombin. This is associated with the occurrence of a trombophilic state. Prothrombin may therefore be associated like FV with both a bleeding condition (prothrombin deficiency) and a thrombophilic state (some dysprothrombinemias). Finally, thrombomodulin resistance has been defined in liver cirrhosis. These patients often show an increased ratio between FVIII levels and protein C. This imbalance may be partly responsible for the frequent presence of portal vein thrombosis seen in these patients. All these studies have greatly increased the complexity of the clotting mechanisms and interactions. They have cast light on clinical events which had remained unknown or ill-defined.
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Affiliation(s)
- A Girolami
- Department of Medicine, University of Padua Medical School, Via Ospedale 105, 35128, Padua, Italy.
| | - E Cosi
- Department of Medicine, University of Padua Medical School, Via Ospedale 105, 35128, Padua, Italy
| | - S Ferrari
- Department of Medicine, University of Padua Medical School, Via Ospedale 105, 35128, Padua, Italy
| | - B Girolami
- Division of Medicine, Padua City Hospital, Padua, Italy
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Landry S, Tanguay JF, Lordkipanidzé M. Personalizing antiplatelet therapies: What have we learned from recent trials? Platelets 2017. [DOI: 10.1080/09537104.2017.1320372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sébastien Landry
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Tanguay
- Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- Department of medicine, Montreal Heart Institute, Montréal, Québec, Canada
| | - Marie Lordkipanidzé
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
- Research center, Montreal Heart Institute, Montréal, Québec, Canada
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12
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Cohen A, Imfeld S, Markham J, Granziera S. The use of aspirin for primary and secondary prevention in venous thromboembolism and other cardiovascular disorders. Thromb Res 2015; 135:217-25. [DOI: 10.1016/j.thromres.2014.11.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 01/23/2023]
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13
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Varnell CD, Goldstein SL, Yee DL, Teruya J, Guyer KE, Siddiqui S, Jefferies JL. Age-related differences in urinary 11-dehydroxythromboxane B2 between infants, children, and adolescents: another example of developmental hemostasis? Pediatr Blood Cancer 2014; 61:2074-6. [PMID: 24803308 DOI: 10.1002/pbc.25089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022]
Abstract
Our study was developed to ascertain reference ranges of 11-dehydrothromboxane B2 (11-dhTXB2) in the urine of healthy pediatric subjects. Urine samples were analyzed using the AspirinWorks™ assay that measures levels of 11-dehydrothromboxane B2. 128 individuals (2 months to 18 years) were identified as healthy and not receiving aspirin. When adjusted as picograms/milligrams urine creatinine, there was a negative correlation between age and level of 11-dehydrothromboxane B2 (P = 0.0001). This study confirms a negative correlation between age and level of urinary 11-dehydrothromboxane B2 and provides a set of age-specific reference ranges.
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Affiliation(s)
- Charles D Varnell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Takigawa T, Suzuki K, Sugiura Y, Suzuki R, Takano I, Shimizu N, Tanaka Y, Hyodo A. Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging. Neuroradiology 2014; 56:1079-86. [PMID: 25185529 DOI: 10.1007/s00234-014-1421-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/25/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The introduction of the balloon remodeling and stent-assisted technique has revolutionized the approach to coil embolization for wide-neck aneurysms. The purpose of this study was to determine the frequency of thromboembolic events associated with single balloon-assisted, double balloon-assisted, and stent-assisted coil embolization for asymptomatic unruptured aneurysms. METHODS A retrospective review was undertaken by 119 patients undergoing coiling with an adjunctive technique for unruptured saccular aneurysms (64 single balloon, 12 double balloon, 43 stent assisted). All underwent diffusion-weighted imaging (DWI) within 24 h after the procedure. RESULTS DWI showed hyperintense lesions in 48 (40%) patients, and ten (21%) of these patients incurred neurological deterioration (permanent, two; transient, eight). Hyperintense lesions were detected significantly more often in procedures with the double balloon-assisted technique (7/12, 58%) than with the single balloon-assisted technique (16/64, 25%, p = 0.05). Occurrence of new lesions was significantly higher with the use of stent-assisted technique (25/43, 58%) than with the single balloon-assisted technique (p = 0.001). Symptomatic ischemic rates were similar between the three groups. The increased number of microcatheters was significantly related to the DWI abnormalities (two microcatheters, 15/63 (23.8%); three microcatheters, 20/41 (48.8%) (p = 0.008); four microcatheters, 12/15 (80%) (p = 0.001)). CONCLUSION Thromboembolic events detected on DWI related to coil embolization for unruptured aneurysms are relatively common, especially in association with the double balloon-assisted and stent-assisted techniques. Furthermore, the number of microcatheters is highly correlated with DWI abnormalities. The high rate of thromboembolic events suggests the need for evaluation of platelet reactivity and the addition or change of antiplatelet agents.
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Affiliation(s)
- Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan,
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15
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Impact of high glucose concentration on aspirin-induced acetylation of human serum albumin: An in vitro study. EUPA OPEN PROTEOMICS 2014. [DOI: 10.1016/j.euprot.2014.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Aspirin (acetylsalicylic acid) is one of the main therapeutic medications used in the prevention of thromboembolic vascular events. Aspirin exhibits its antiplatelet action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Aspirin resistance, as measured in vitro, is the inability of aspirin to reduce platelet activation and aggregation by failure to suppress the platelet production of TXA2. Laboratory tests of platelet TXA2 production or platelet function dependent on TXA2 can detect aspirin resistance in vitro. The clinical implication of this laboratory definition has not yet been elucidated via prospective trials that have controlled for confounders, such as hypertension, diabetes and dyslipidemia. Large meta-analyses have found low-dose aspirin to be as effective as high-dose aspirin in preventing vascular events, making a dose-dependent improvement in laboratory response clinically irrelevant. Possible causes of aspirin resistance include poor compliance, inadequate dose, drug interactions, genetic polymorphisms of cyclooxygenase-1, increased platelet turnover and upregulation of non-platelet pathways of thromboxane production. However, there is currently no standardized approach to the diagnosis and no proven effective treatment for aspirin resistance. Further research exploring the mechanisms of aspirin resistance is needed in order to better define aspirin resistance, as well as to develop a standardized laboratory test that is specific and reliable, and can correlate with the clinical risk of vascular events. The intent of this paper is to review the literature discussing possible mechanisms, diagnostic testing and clinical trials of aspirin resistance and to discuss its clinical relevance as it pertains to cerebrovascular and cardiovascular disease.
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Affiliation(s)
- Darshana Patel
- Department of Neurlogy, University of Massachusetts Memorial Medical Center, Worcester, MA 01655, USA.
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17
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Li J, Song M, Jian Z, Guo W, Chen G, Jiang G, Wang J, Wu X, Huang L. Laboratory Aspirin Resistance and the Risk of Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease on Confirmed Aspirin Adherence. J Atheroscler Thromb 2014; 21:239-47. [DOI: 10.5551/jat.19521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Factors influencing Multiplate whole blood Impedance Platelet Aggregometry measurements, during aspirin treatment in acute ischemic stroke. Blood Coagul Fibrinolysis 2013; 24:830-8. [DOI: 10.1097/mbc.0b013e3283655640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Enomoto Y, Yoshimura S. Antiplatelet therapy for carotid artery stenting. INTERVENTIONAL NEUROLOGY 2013; 1:151-63. [PMID: 25187775 PMCID: PMC4031772 DOI: 10.1159/000351686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Carotid artery stenting (CAS) is less invasive and has a lower incidence of systemic complications such as myocardial infarction compared with carotid endarterectomy. However, CAS is known to have a high incidence of ischemic complications due to distal thromboembolism. Progress has been made in the development of various distal protection devices and protection methods aimed at preventing thromboembolism. Similar to these methods, perioperative antiplatelet therapy is also able to play a very important role in the prevention of ischemic events. Dual antiplatelet therapy has become standard for perioperative management of CAS.
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Affiliation(s)
- Yukiko Enomoto
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu City, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu City, Japan
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20
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Triple antiplatelet therapy with addition of cilostazol to aspirin and clopidogrel for Y-stent-assisted coil embolization of cerebral aneurysms. Acta Neurochir (Wien) 2013; 155:1549-57. [PMID: 23715948 DOI: 10.1007/s00701-013-1771-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dual antiplatelet therapy for stent-assisted coiling of cerebral aneurysms is essential to prevent thromboembolic complications. There is concern that Y-stent-assisted coiling may increase thromboembolic complications compared with coiling with a single stent. Several reports have demonstrated that cilostazol may improve clopidogrel responsiveness. We investigated whether triple antiplatelet therapy with addition of cilostazol to aspirin plus clopidogrel for Y-stents can prevent thromboembolic events. METHODS Between July 2010 and October 2012, we treated 40 consecutive aneurysms with coil embolization using Enterprise stents. At the peri-procedural period, dual antiplatelet agents (100 mg aspirin and 75 mg clopidogrel) were used for the single stent group (n = 36), and triple antiplatelet agents (addition of 200 mg cilostazol) were used for the Y-stent group (n = 4). We evaluated post-operative diffusion-weighted imaging (DWI) and any complications. We assessed the following for statistical analysis: age, sex, aneurysm location, shape, and size, neck size, size of parent vessels, and stent length. RESULTS We found two neurological peri-procedural complications: one transient ischemic attack and one infarction. Both complications belonged to the Y-stent group, which was a significant factor of thromboembolic events (P = 0.008). There were no other significant factors related to neurological complications or positive DWI. For subgroup analysis of the single stent group, stent length was significantly longer in positive DWI than negative DWI (P = 0.04). In the follow-up period of 20 ± 8.6 months, there were no symptomatic late complications in any patients. CONCLUSIONS Although the number of patients in the Y-stent group is small, this group had a significantly higher risk of thromboembolic complications. While our protocol of a routine dose of dual antiplatelet therapy may be sufficient for single stent therapy, our protocol of a routine dose of triple antiplatelet therapy for Y-stents may not prevent thromboembolic events. This suggests that evaluation of platelet function may be essential, especially for Y-stents.
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21
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Valsami S, Asmis LM. A brief review of 50 years of perioperative thrombosis and hemostasis management. Semin Hematol 2013; 50:79-87. [PMID: 24216167 DOI: 10.1053/j.seminhematol.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Perioperative thrombosis and hemostasis management has changed dramatically over the past 50 years. From two anticoagulants and one anti-aggregant, the number of currently available drugs has recently increased several-fold, leaving clinicians with the problem of choosing the optimal agent. Individualized preoperative assessment of bleeding risk based on bleeding history and testing limited to high-risk patients is an emerging concept. Based on the identification of risk factors for venous thromboembolism (VTE), pharmacologic and non-pharmacologic strategies for perioperative VTE prophylaxis have had a major impact on patient outcome. For patients undergoing surgery who are treated with anticoagulants and anti-aggregants, "bridging" strategies have been proposed. Bleeding management strategies have shifted focus from replacing lost blood volume to new approaches aimed at preventing blood loss, reducing the potential complications of blood loss, and preventing the transfusion of blood products. For some areas of perioperative thrombosis and hemostasis management, randomized controlled trial (RCT) data are emerging, but the database remains insufficient to date. Clearly, more RCTs need to be published for perioperative thrombosis and hemostasis management to become an evidence-based approach.
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Affiliation(s)
- Serena Valsami
- Blood Transfusion Department, Areteion Hospital, Athens University Medical School, Athens, Greece
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22
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Yokoyama H, Ito N, Soeda S, Ozaki M, Suzuki Y, Watanabe M, Kashiwakura E, Kawada T, Ikeda N, Tokuoka K, Kitagawa Y, Yamada Y. Prediction of Antiplatelet Effects of Aspirin In Vivo Based on In Vitro Results. Clin Appl Thromb Hemost 2013; 19:600-7. [DOI: 10.1177/1076029613484084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to establish a method to predict the antiplatelet effects of aspirin in vivo based on in vitro results. Aspirin in 5 different concentrations was added to the platelet-rich plasma samples, and the rates of platelet aggregation induced by collagen were determined in vitro. In addition, platelet aggregation and plasma drug concentration values were determined in vivo before and after the administration of aspirin (162 mg). The 50% effective concentration (EC50) values obtained from the in vivo and in vitro experiments were shown to have relevance, because the EC50 ratio for each subject was the same (0.23 ± 0.03). The actual and predicted values for the rate of inhibition of platelet aggregation were well correlated ( P < .0001, r = .95) when the predicted rate was determined using the present method. Our results suggest that the antiplatelet effects of aspirin can be predicted using blood samples obtained before its administration.
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Affiliation(s)
- Haruko Yokoyama
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Naoko Ito
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Shinji Soeda
- Department of Pharmacy, Tokai University of Hachioji Hospital, Hachioji, Japan
| | - Masahiro Ozaki
- Department of Pharmacy, Tokai University of Hachioji Hospital, Hachioji, Japan
| | - Yuji Suzuki
- Department of Pharmacy, Tokai University of Oiso Hospital, Nakagun, Japan
| | - Masayuki Watanabe
- Department of Pharmacy, Tokai University of Hachioji Hospital, Hachioji, Japan
| | - Emiko Kashiwakura
- Central Clinical Laboratory, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Tsutomu Kawada
- Central Clinical Laboratory, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Noriyuki Ikeda
- Central Clinical Laboratory, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Kentaro Tokuoka
- Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Yasuhisa Kitagawa
- Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Yasuhiko Yamada
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
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Harmon S, Inkielewicz-Stepniak I, Jones M, Ledwidge M, Santos-Martinez MJ, Medina C, Radomski MW, Gilmer JF. Mechanisms of aggregation inhibition by aspirin and nitrate-aspirin prodrugs in human platelets. J Pharm Pharmacol 2011; 64:77-89. [DOI: 10.1111/j.2042-7158.2011.01380.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
Aspirin is the mainstay of anti-platelet therapy in the secondary prevention of cardiovascular disease. However, problems with aspirin safety and resistance demand clinical strategies based on multiple pharmacological approaches. Prodrugs of aspirin may offer beneficial effects in terms of gastro-intestinal safety and multiple pharmacological approaches. However, the pharmacological profile of aspirin prodrugs in human platelets has not been completed yet. We aimed to compare the effects of aspirin and prodrugs of aspirin (1–5) on human platelet aggregation stimulated by ADP and collagen and associated receptor expression (GPIIb/IIIa and P-selectin) in platelet-rich plasma (PRP) and washed platelets (WP).
Methods
As aspirin is released from prodrugs following esterase hydrolysis we studied the expression and activity of butyrylcholineterase (BuChE) and carboxyesterase (CE) in plasma and platelets. The mechanism of prodrug-induced platelet aggregation inhibition was explored by studying the effects of plasma and purified human BuChE on aggregation. Finally, the relative contribution of nitric oxide (NO) bioactivity to nitrate-containing prodrugs of aspirin-induced inhibition of aggregation was determined using 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ,) a selective inhibitor of the soluble guanylyl cyclase.
Key findings
ST0702, 2, a nicotinic acid-aspirin codrug was equipotent with aspirin with respect to inhibition of collagen-induced platelet aggregation. Compound 4, a NO releasing aspirin was the most potent inhibitor of ADP-induced platelet aggregation, an effect partially reversed by ODQ. The platelet inhibitory effects of aspirin prodrugs were time-dependent as the maximal inhibitory effects against collagen-induced aggregation were achieved by aspirin at 2 min, 1 at 5 min and ST0702 at 15 min. The aspirin prodrugs were significantly less potent in WP than in PRP and the reverse was true of aspirin. In the presence of complete BuChE inhibition in PRP, there was almost complete loss of aspirin prodrug, but not aspirin anti-aggregatory activity. Interestingly, CE activity was observed in WP and platelet lysate with pNPA substrate. Accordingly, 1 and ST0702 retained 50% and 100% anti-aggregatory activity at maximal concentrations in WP, which was attenuated in the presence of esterase inhibitor phenylmethylsulphonyl fluoride.
Conclusions
The inhibitory effect of aspirin prodrugs in PRP is due to prodrug activation by BuChE. In contrast, the platelet-inhibitory effects of aspirin prodrugs in WP may be mediated through the activity of platelet CE. Compound 4, a NO-containing aspirin prodrug, may exert dual inhibitory effects in platelets. Thus, aspirin prodrugs effectively inhibit human platelet aggregation and as such may be an alternative to conventional aspirin.
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Affiliation(s)
- Shona Harmon
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | | | - Michael Jones
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Mark Ledwidge
- School of Medicine and Medical Science, University College, Dublin, Ireland
| | | | - Carlos Medina
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Marek W Radomski
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - John F Gilmer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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Abstract
Platelets are a remarkable mammalian adaptation that are required for human survival by virtue of their ability to prevent and arrest bleeding. Ironically, however, in the past century, the platelets' hemostatic activity became maladaptive for the increasingly large percentage of individuals who develop age-dependent progressive atherosclerosis. As a result, platelets also make a major contribution to ischemic thrombotic vascular disease, the leading cause of death worldwide. In this brief review, I provide historical descriptions of a highly selected group of topics to provide a framework for understanding our current knowledge and the trends that are likely to continue into the future of platelet research. For convenience, I separate the eras of platelet research into the "Descriptive Period" extending from ~1880-1960 and the "Mechanistic Period" encompassing the past ~50 years since 1960. We currently are reaching yet another inflection point, as there is a major shift from a focus on traditional biochemistry and cell and molecular biology to an era of single molecule biophysics, single cell biology, single cell molecular biology, structural biology, computational simulations, and the high-throughput, data-dense techniques collectively named with the "omics postfix". Given the progress made in understanding, diagnosing, and treating many rare and common platelet disorders during the past 50 years, I think it appropriate to consider it a Golden Age of Platelet Research and to recognize all of the investigators who have made important contributions to this remarkable achievement..
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Affiliation(s)
- Barry S. Coller
- Laboratory of Blood and Vascular Biology, Rockefeller University, 1230 York Avenue, New York, NY 10065, Tel: 212-327-7490, Fax: 212-327-7493
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25
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Aydinalp A, Atar I, Gulmez O, Atar A, Acikel S, Bozbas H, Ozgul A, Ertan C, Ozin B, Muderrisoglu H. The clinical significance of aspirin resistance in patients with chest pain. Clin Cardiol 2011; 33:E1-7. [PMID: 20155858 DOI: 10.1002/clc.20539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are conflicting data in the literature about the clinical significance of aspirin resistance. HYPOTHESIS We aimed to prospectively evaluate the prevalence of biochemical aspirin resistance in patients on aspirin therapy who were admitted to the emergency clinic with chest pain. We also aimed to evaluate the relation between acute coronary syndromes (ACS) and aspirin resistance. METHODS A total of 338 patients were included in the study. Platelet reactivity was measured with the PFA-100 system (Dade Behring Inc, Deerfield, IL). Aspirin resistance determined by the PFA-100 was defined as a normal collagen and/or epinephrine closure time despite aspirin treatment (<165 s). RESULTS Patients were divided into 4 groups: stable angina pectoris (SAP), unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), ST-elevation myocardial infarction (STEMI), and rule out ACS. Aspirin resistance was found in 81 (24%) patients in all groups. Patients with ACS had significantly more aspirin resistance than patients with rule out ACS or patients with SAP (P < .001). In the SAP group, 31 (19.6%) patients; in the UA/NSTEMI group, 19 (35.8%) patients; in the STEMI group, 14 (50%) patients; and in the rule out ACS group, 17 (17.2%) patients had aspirin resistance (P < .001). In the multivariate analysis, cardiac biomarker elevation on admission to emergency department and platelet count appeared as independent factors predictive of aspirin resistance. CONCLUSIONS We demonstrated that incidence of aspirin resistance was significantly higher in patients who were finally diagnosed as ACS, especially in aspirin-taking patients admitted to the emergency clinic with STEMI.
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Affiliation(s)
- Alp Aydinalp
- Department of Cardiology, Faculty of Medicine, University of Baskent, Ankara, Turkey.
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Neafsey PJ, M’lan CE, Ge M, Walsh SJ, Lin CA, Anderson E. Reducing Adverse Self-Medication Behaviors in Older Adults with Hypertension: Results of an e-health Clinical Efficacy Trial. AGEING INTERNATIONAL 2011; 36:159-191. [PMID: 21654869 PMCID: PMC3092917 DOI: 10.1007/s12126-010-9085-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A randomized controlled efficacy trial targeting older adults with hypertension (age 60 and over) provided an e-health, tailored intervention with the "next generation" of the Personal Education Program (PEP-NG). Eleven primary care practices with advanced practice registered nurse (APRN) providers participated. Participants (N = 160) were randomly assigned by the PEP-NG (accessed via a wireless touchscreen tablet computer) to either control (entailing data collection and four routine APRN visits) or tailored intervention (involving PEP-NG intervention and four focused APRN visits) group. Compared to patients in the control group, patients receiving the PEP-NG e-health intervention achieved significant increases in both self-medication knowledge and self-efficacy measures, with large effect sizes. Among patients not at BP targets upon entry to the study, therapy intensification in controls (increased antihypertensive dose and/or an additional antihypertensive) was significant (p = .001) with an odds ratio of 21.27 in the control compared to the intervention group. Among patients not at BP targets on visit 1, there was a significant declining linear trend in proportion of the intervention group taking NSAIDs 21-31 days/month (p = 0.008). Satisfaction with the PEP-NG and the APRN provider relationship was high in both groups. These results suggest that the PEP-NG e-health intervention in primary care practices is effective in increasing knowledge and self-efficacy, as well as improving behavior regarding adverse self-medication practices among older adults with hypertension.
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Affiliation(s)
- Patricia J. Neafsey
- School of Nursing Unit 2026, University of Connecticut, Storrs, CT 06269 USA
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
| | - Cyr E. M’lan
- Department of Statistics, University of Connecticut, Storrs, CT 06269 USA
| | - Miaomiao Ge
- Department of Statistics, University of Connecticut, Storrs, CT 06269 USA
| | - Stephen J. Walsh
- Center for Nursing Scholarship, School of Nursing, University of Connecticut, Storrs, CT 06269 USA
| | - Carolyn A. Lin
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
- Department of Communication Sciences, University of Connecticut, Storrs, CT 06269 USA
| | - Elizabeth Anderson
- School of Nursing Unit 2026, University of Connecticut, Storrs, CT 06269 USA
- Center for Health Intervention and Prevention (CHIP), University of Connecticut, Storrs, CT 06269 USA
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Schrör K, Huber K, Hohlfeld T. Functional testing methods for the antiplatelet effects of aspirin. Biomark Med 2011; 5:31-42. [DOI: 10.2217/bmm.10.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
At antiplatelet doses of 75–325 mg/day, aspirin irreversibly inhibits the platelet cyclooxygenase (COX)-1-dependent thromboxane A2 (TXA2) formation. This is the pharmacological mode of action of aspirin, and it can be predicted that if aspirin does not inhibit COX-1 sufficiently, patients will not benefit from its antiplatelet effects. A pharmacodynamic failure of aspirin occurs in 1–2% of patients. The vast majority of atherothrombotic events in patients treated with aspirin result from mechanisms that are dependent on residual (non-COX-1-dependent) platelet reactivity. Global tests of platelet activation in vitro may identify patients with high residual platelet reactivity but are not sufficiently specific to test the pharmacological effect of aspirin. A further problem is the absence of standardized normal ranges for many assays and the fact that different equipment measures different signals, which are also influenced by the agonist and the anticoagulant used. Similar considerations apply for the determination of platelet-derived biomarkers such as circulating P-selectin, soluble CD40 ligand and others. The direct measurement of inhibition of thromboxane-forming capacity is the most specific pharmacological assay for aspirin. However, there is no linear correlation between inhibition of TXA2 formation and inhibition of platelet function. Measurement of urinary levels of the TXB2 metabolite, 11-dehydro-thromboxane B2, represents an index of TXA2 biosynthesis in vivo, but is also sensitive to other cellular sources of TXA2. One general problem of all assays is the relationship with clinical outcome, which is still unclear. Monitoring aspirin treatment by testing platelet function or measuring biomarkers in clinical practice should not be recommended until a clear relationship for the predictive value of these assays for clinical outcome has been established.
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Affiliation(s)
| | - Kurt Huber
- 3. Medizinische Abteilung (Kardiologie), Wilhelminenspital, Montleartstrasse 37, 1160 Wien, Austria
| | - Thomas Hohlfeld
- Institut für Pharmakologie und Klinische Pharmakologie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum, Moorenstraße 5, 40225 Düsseldorf, Germany
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Yassine HN, Davis-Gorman G, Stump CS, Thomson SS, Peterson J, McDonagh PF. Clinical determinants of aspirin resistance in diabetes. Diabetes Res Clin Pract 2010; 90:e19-21. [PMID: 20719400 PMCID: PMC2962939 DOI: 10.1016/j.diabres.2010.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 02/07/2023]
Abstract
Recent studies indicate that not all diabetic subjects benefit from aspirin therapy. Our objective is to characterize diabetic subjects with aspirin resistance using urine thromboxane, and VerifyNow measures. Our results suggest that cardiovascular disease, microalbuminuria, poor diabetes control, and increased waist circumference help identify aspirin resistance in diabetes.
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Affiliation(s)
- Hussein N Yassine
- Department of Medicine, Division of Endocrinology, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA.
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Yassine HN, Davis-Gorman G, Stump CS, Thomson SS, Peterson J, McDonagh PF. Effect of glucose or fat challenge on aspirin resistance in diabetes. Int J Endocrinol 2010; 2010:820876. [PMID: 21318184 PMCID: PMC3034931 DOI: 10.1155/2010/820876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/01/2010] [Indexed: 11/18/2022] Open
Abstract
Aspirin has lower antiplatelet activity in diabetic patients. Our aim is to study the roles of acute hyperglycemia and hyperlipidemia on aspirin function in diabetic subjects with and without cardiovascular disease. Using urine thromboxane (pg/mg creatinine) and VerifyNow (Aspirin Resistance Measures-ARU), we investigated diabetic subjects during a 2-hour glucose challenge (n = 49) or a 4-hour fat challenge (n = 11). All subjects were currently taking aspirin (81 or 325 mg). After fat ingestion, urine thromboxane increased in all subjects (Mean ± SE before: after) (1209 ± 336: 1552 ± 371, P = .01), while we noted a trend increase in VerifyNow measures (408 ± 8: 431 ± 18, P = .1). The response to glucose ingestion was variable. Diabetic subjects with cardiac disease and dyslipidemia increased thromboxane (1693 ± 364: 2799 ± 513, P < .05) and VerifyNow (457.6 ± 22.3: 527.1 ± 25.8, P < .05) measures after glucose. We conclude that saturated fat ingestion increases in vivo thromboxane production despite aspirin therapy.
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Affiliation(s)
- Hussein N. Yassine
- Division of Endocrinology, Department of Medicine, Arizona Health Sciences Center, University of Arizona, 1656 E Mabel Street, Tucson, AZ 85724, USA
- *Hussein N. Yassine:
| | - Grace Davis-Gorman
- Cardiovascular and Thoracic Surgery and the Sarver Heart Center, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA
| | - Craig S. Stump
- Division of Endocrinology, Department of Medicine, Arizona Health Sciences Center, University of Arizona, 1656 E Mabel Street, Tucson, AZ 85724, USA
- Southern Arizona VA Health Care System, Tucson, AZ 85723, USA
| | - Stephen S. Thomson
- Division of Endocrinology, Department of Medicine, Arizona Health Sciences Center, University of Arizona, 1656 E Mabel Street, Tucson, AZ 85724, USA
- Southern Arizona VA Health Care System, Tucson, AZ 85723, USA
| | - Justin Peterson
- Division of Endocrinology, Department of Medicine, Arizona Health Sciences Center, University of Arizona, 1656 E Mabel Street, Tucson, AZ 85724, USA
| | - Paul F. McDonagh
- Cardiovascular and Thoracic Surgery and the Sarver Heart Center, Arizona Health Sciences Center, University of Arizona, Tucson, AZ 85724, USA
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Bolliger D, Seeberger MD, Tanaka KA, Dell-Kuster S, Gregor M, Zenklusen U, Grapow M, Tsakiris DA, Filipovic M. Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry. Platelets 2009; 20:458-65. [DOI: 10.3109/09537100903236462] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pedersen SB, Grove EL, Nielsen HL, Mortensen J, Kristensen SD, Hvas AM. Evaluation of aspirin response by Multiplate® whole blood aggregometry and light transmission aggregometry. Platelets 2009; 20:415-20. [DOI: 10.1080/09537100903100643] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Salama MM, Morad ARM, Saleh MA, Sabri NA, Zaki MM, ElSafady LA. Resistance to low-dose aspirin therapy among patients with acute coronary syndrome in relation to associated risk factors. J Clin Pharm Ther 2009; 37:630-6. [PMID: 23121257 DOI: 10.1111/j.1365-2710.2009.01083.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A substantial proportion of patients have recurrence of vascular events despite daily intake of low-dose aspirin therapy. Therefore, different patients may require different aspirin dosages to achieve complete inhibition of platelet function. OBJECTIVE The aim of this work was to measure the response to low-dose aspirin therapy (150 mg/day) among patients with unstable angina or non-ST-segment elevation myocardial infarction and to find out whether titrating aspirin dosage to 300 mg/day, would provide a better therapeutic response in the resistant cases. Moreover, we also aimed to study any association between aspirin non-responsiveness and atherothrombotic risk factors. METHODS The antiplatelet effect of 150 mg/day aspirin was studied prospectively in 50 consecutive patients with unstable angina or non-ST-segment elevation myocardial infarction. Platelet aggregation was measured using optical platelet aggregometry and serum thromboxane B(2) level. Aspirin resistance was defined as collagen (1 μg/mL) and adenosine diphosphate (ADP) (5 μmol/L)-induced platelet aggregation of ≥ 40% when compared with control values. Twenty healthy age- and sex-matched individuals were taken as a control group. All patients were subjected to complete medical history (risk factors, medications), thorough clinical examination, ECG, coronary angiography and laboratory investigations including: complete haemogram, coagulation, kidney, liver and lipid profiles, fasting blood glucose and glycated haemoglobin (HbA(1C) ). RESULTS Eleven of 50 patients (22%) were found to be aspirin resistant. A highly significant difference was found between the mean values of ADP, collagen-induced platelet aggregation percentage and thromboxane B(2) level after aspirin 150 mg/day when compared with the corresponding mean values after aspirin 300 mg/day among the resistant patients (66 ± 7.01%, 62 ± 4.34% and 620 ± 64.58 pg/mL, respectively, vs. 26.87 ± 2.85%, 16.5 ± 3.8% and 77 ± 11.3 pg/mL) indicating enhanced response to aspirin after escalating the dose. The presence of atherothrombotic risk factors (hypertension, smoking, family history of ischaemic heart disease and previous MI) were not statistically different between aspirin-resistant and aspirin-sensitive patients. However, there was a highly significant difference between the aspirin sensitive and the resistant patients regarding the other risk factors (diabetes mellitus and dyslipidaemia) (P < 0.01). CONCLUSION There is inter-individual variability in response to the antiplatelet effect of standard doses of aspirin (150, 300 mg/day). The response to aspirin 300 mg/day is enhanced in resistant patients when compared to 150 mg/day. There was a significant association between aspirin resistance and atherothrombotic risk factors (diabetes, hyperlipidaemia and obesity).
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Affiliation(s)
- M M Salama
- Department of Clinical Pharmacy, Ain Shams University, Cairo, Egypt.
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Gouya G, Jilma B, Niel M, Eichelberger B, Wolzt M, Panzer S. Cross validation of aspirin effect in healthy individuals by Impact-R and PFA-100: A double blind randomized placebo controlled trial. Platelets 2009; 20:171-6. [DOI: 10.1080/09537100902745117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Margolis MK, Halling K, Sörstadius E, Næsdal J, Manson S, Coyne K. Upper Gastrointestinal Symptoms Experienced by Users of Low-Dose Aspirin (Acetylsalicylic Acid) [75–325 mg/day] for Primary and Secondary Coronary Artery Disease Prevention. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2009; 2:89-93. [DOI: 10.2165/01312067-200902020-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hedegaard SS, Hvas AM, Grove EL, Refsgaard J, Rocca B, Daví G, Kristensen SD. Optical platelet aggregation versus thromboxane metabolites in healthy individuals and patients with stable coronary artery disease after low-dose aspirin administration. Thromb Res 2009; 124:96-100. [DOI: 10.1016/j.thromres.2008.12.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 12/06/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
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Li JB, Dong HM, Jian Z, Wu XJ, Zhao XH, Yu SY, Huang L. Responsiveness to aspirin in patients with unstable angina pectoris by whole blood aggregometry. Int J Clin Pract 2009; 63:407-16. [PMID: 19222626 DOI: 10.1111/j.1742-1241.2008.01976.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To evaluate aspirin responsiveness in patients with unstable angina pectoris (UAP) by whole blood aggregometry. Another goal was to differentiate aspirin-resistant patients into pharmacokinetic or pharmacodynamic type. METHODS We measured platelet aggregation by determining impedance values in 70 normal volunteers and 104 UAP patients on aspirin (100 mg/day > or = 7 days) in four inducing conditions [1 microg/ml collagen, 2 microg/ml collagen, 5 micromol/l adenosine diphosphate (ADP) and 10 micromol/l ADP]. We calculated a cut-off value based on data from normal volunteers to define aspirin responsiveness in cases. Then, the correlation and agreement between the results in the four conditions was analysed to choose a preferred inducing condition for identification of aspirin resistance. Aliquots from all samples were incubated with 0.1 mmol/l aspirin and measured again for aspirin-resistant classification. RESULTS Aspirin resistance was observed in 38 patients (36.5%), 51 patients (49.0%), 67 patients (64.4%) and 67 patients (64.4%), respectively, for 1 microg/ml collagen, 2 microg/ml collagen, 5 micromol/l ADP and 10 micromol/l ADP among 104 patients. Collagen at low concentration was suggested as a preferred agent for detecting aspirin inhibitory effect according to the coefficient of sensitivity. After incubation, only three among 38 aspirin-resistant patients showed normal platelet aggregation and were classified into pharmacodynamic type. CONCLUSIONS In the presence of collagen at low concentration (1 microg/ml), the prevalence of aspirin resistance is about 36.5% in UAP patients, and according to a classification specific for resistant patients, most of the aspirin 'resistance' is just because of pharmacokinetic issues.
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Affiliation(s)
- J B Li
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Variability of non-response to aspirin in patients with peripheral arterial occlusive disease during long-term follow-up. Ann Hematol 2009; 88:979-88. [DOI: 10.1007/s00277-009-0708-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
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Kuliczkowski W, Witkowski A, Polonski L, Watala C, Filipiak K, Budaj A, Golanski J, Sitkiewicz D, Pregowski J, Gorski J, Zembala M, Opolski G, Huber K, Arnesen H, Kristensen SD, De Caterina R. Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J 2008; 30:426-35. [PMID: 19174428 DOI: 10.1093/eurheartj/ehn562] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Wiktor Kuliczkowski
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
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Achterberg S, Kappelle LJ, Algra A. Prognostic modelling in ischaemic stroke study, additional value of genetic characteristics. Rationale and design. Eur Neurol 2008; 59:243-52. [PMID: 18264013 DOI: 10.1159/000115638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 08/31/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM The prediction of prognosis after cerebral infarction might be improved by genetic information. The aim of the Prognostic Modelling in Ischaemic Stroke study is to develop 2 different prognostic models on the basis of traditional vascular risk factors and genetic information in patients who have suffered from cerebral ischaemia of arterial origin, 1 concerning new ischaemic and the other new haemorrhagic events. METHODS Polymorphisms and haplotypes describing the haemostatic system and those that influence antithrombotic drug activity will be identified in a cohort of 1,200 patients with cerebral ischaemia of arterial origin who will be followed up for a mean of 6.5 years. In total, 312 ischaemic and 78 haemorrhagic events are anticipated. With a prevalence of a genetic characteristic of 10% a relative risk of 1.4 (95% confidence interval = 1.1-1.8) for ischaemic events and of 1.8 (95% confidence interval = 1.0-3.2) for haemorrhagic events can be estimated with sufficient precision. To determine the additional prognostic value of genetic characteristics the area under the ROC curves of 2 separate models will be compared: 1 based on non-genetic risk factors only, the other also including genetic data.
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Affiliation(s)
- S Achterberg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands.
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