Influence of pre-analytical time and temperature conditions on serum thromboxane B 2 levels

Once- versus Twice-Daily Aspirin in Patients at High Risk of Thrombotic Events: Systematic Review and Meta-Analysis

BACKGROUND

Acetylsalicylic acid (ASA) is a frequently used antiplatelet agent, although some individuals have reduced antiplatelet responses on ASA, with recurrent ischemic events. It has been proposed that shortening the ASA dosing interval may overcome the time-dependent renewal of the drug target, leading to a greater antiplatelet effect. We conducted a systematic review of randomized controlled trials (RCTs) to determine the efficacy of once- versus twice-daily ASA in conditions with increased platelet turnover.

METHODS

We conducted a systematic review and meta-analysis by searching the CENTRAL, MEDLINE, and Embase databases for RCTs assessing once- versus twice-daily ASA. Data were screened, extracted, and appraised by two independent reviewers, and were pooled using a random-effects model. The primary outcomes were major adverse cardiovascular events (MACEs) and serum thromboxane B2 (TxB2). Other pharmacodynamic measures were retrieved as secondary outcomes. Results were reported as mean differences with corresponding 95% confidence intervals (CIs). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Seven RCTs were included, enrolling 379 participants overall. None of the studies reported clinical outcomes. Pooled results showed that compared with once-daily ASA, twice-daily ASA was associated with a decrease in mean TxB2 of 1.42 ng/mL (95% CI - 2.71 to - 0.13; I² = 66%). We found no differences in subgroup analyses based on disease subtype, trial blinding, or trial design. A greater antiplatelet activity of the twice-daily regimen was also found when using PFA-100-ADP methods, although not when using the VerifyNow, LTA-AA, and multiplate methods.

CONCLUSIONS

Twice-daily ASA was associated with a greater antiplatelet effect compared with standard once-daily ASA.

Evening aspirin intake results in higher levels of platelet inhibition and a reduction in reticulated platelets - a window of opportunity for patients with cardiovascular disease?

Cardiovascular events occur most frequently in the early morning. Similarly, the release of reticulated platelets (RP) by megakaryocytes has a peak in the late night and early morning. Which aspirin regimen most effectively inhibits platelets during these critical hours is unknown. Hence, the primary objective of this trial was to assess platelet function and RP levels at 8.00 AM, in stable cardiovascular (CVD) patients, during three different aspirin regimens. In this open-label randomized cross-over study subjects were allocated to three sequential aspirin regimens: once-daily (OD) 80 mg morning; OD-evening, and twice-daily (BID) 40 mg. Platelet function was measured at 8.00 AM & 8.00 PM by serum Thromboxane B₂ (sTxB₂) levels, the Platelet Function Analyzer (PFA)-200® Closure Time (CT), Aspirin Reaction Units (ARU, VerifyNow®), and RP levels. In total, 22 patients were included. At 8.00 AM, sTxB₂ levels were the lowest after OD-evening in comparison with OD-morning (p = <0.01), but not in comparison with BID. Furthermore, RP levels were similar at 8.00 AM, but statistically significantly reduced at 8.00 PM after OD-evening (p = .01) and BID (p = .02) in comparison with OD-morning. OD-evening aspirin intake results in higher levels of platelet inhibition during early morning hours and results in a reduction of RP levels in the evening. These findings may, if confirmed by larger studies, be relevant to large groups of patients taking aspirin to reduce cardiovascular risk.

Oral administration of leeches (Shuizhi): A review of the mechanisms of action on antiplatelet aggregation

ETHNOPHARMACOLOGICAL RELEVANCE

The leeches (Shuizhi) comprise approximately 680 species distributed throughout the world. As recorded, they have been used as traditional Chinese medicines since the Eastern Han Dynasty, where they were claimed for promote blood circulation and eliminate blood stasis. And have been used to prevent CVDs by exerting multiple effects when orally administered, one of which is the significant inhibition of platelet aggregation. Its ability to exert this effect has been extensively investigated in vivo and in clinical practice.

AIM OF STUDY

The aim of this review is to summarize and analyse the antiplatelet aggregation mechanisms of leeches by oral administration, support their therapeutic potential and uncover opportunities for future research.

MATERIALS AND METHODS

Relevant studies from 1980 to 2018 on leeches and platelet aggregation were collected from ancient books, pharmacopoeia, reports and theses via library and internet databases (PubMed, CNKI, Google Scholar, Web of science, SciFinder, Springer and Elsevier).

RESULTS

Leeches is a unique animal medicine, they can prevent platelet aggregation by inhibiting ADP-induced platelet aggregation, increasing PGI₂, decreasing TXA₂ and Ca²⁺, and possibly recovering endothelial cell dysfunction. Leeches also exhibit a strong ability to activate eNOS, leading to an increase in platelet-derived NO. Additionally, the pteridine compounds obtained and identified from leeches have sulfur structure similar to those of other antiplatelet aggregation agents, such as ticlopidine, clopidogrel and ticagrelor.

CONCLUSION

The present review has focused on the related antiplatelet aggregation mechanisms, dipyridine compounds and toxicological information of leeches. According to the reported data, leeches have emerged as a good source of natural medicine for the treatment of antiplatelet aggregation agents and also make educated guesses for material basis of effects on antiplatelet aggregation. This review can help provide new insights for further studies in association with the development of effective antiplatelet aggregation drugs from natural medicines, especially leeches.

The Aspirin Regimens in Essential Thrombocythemia (ARES) phase II randomized trial design: Implementation of the serum thromboxane B2 assay as an evaluation tool of different aspirin dosing regimens in the clinical setting

Once-daily (od), low-dose aspirin (75–100 mg) is recommended to reduce the thrombotic risk of patients with essential thrombocytemia (ET). This practice is based on data extrapolated from other high-risk patients and an aspirin trial in polycythemia vera, with the assumption of similar aspirin pharmacodynamics in the two settings. However, the pharmacodynamics of low-dose aspirin is impaired in ET, reflecting accelerated renewal of platelet cyclooxygenase (COX)-1. ARES is a parallel-arm, placebo-controlled, randomized, dose-finding, phase II trial enrolling 300 ET patients to address two main questions. First, whether twice or three times 100 mg aspirin daily dosing is superior to the standard od regimen in inhibiting platelet thromboxane (TX)A₂ production, without inhibiting vascular prostacyclin biosynthesis. Second, whether long-term persistence of superior biochemical efficacy can be safely maintained with multiple vs. single dosing aspirin regimen. Considering that the primary study end point is serum TXB₂, a surrogate biomarker of clinical efficacy, a preliminary exercise of reproducibility and validation of this biomarker across all the 11 participating centers was implemented. The results of this preliminary phase demonstrate the importance of controlling reproducibility of biomarkers in multicenter trials and the feasibility of using serum TXB₂ as a reliable end point for dose-finding studies of novel aspirin regimens.