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1.
Otolaryngol Clin North Am ; 56(1): 107-124, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36283868

RESUMO

Aspirin-exacerbated respiratory disease (AERD) is characterized by abnormal arachidonic acid metabolism leading to chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and upper and/or lower respiratory symptoms after ingestion of cyclooxygenase-1 inhibiting nonsteroidal antiinflammatory drugs. Diagnosis is clinical and may involve an aspirin challenge. Inflammatory biomarkers may be useful for diagnosis and treatment monitoring. Conventional medical management for asthma and CRSwNP is often inadequate. Endoscopic sinus surgery followed by continued medical management with or without aspirin desensitization frequently improves symptoms and objective disease measures. Biological agents targeting eosinophilic inflammation are promising alternatives to conventional management.


Assuntos
Asma Induzida por Aspirina , Asma , Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/induzido quimicamente , Rinite/diagnóstico , Rinite/terapia , Asma Induzida por Aspirina/diagnóstico , Asma Induzida por Aspirina/terapia , Sinusite/induzido quimicamente , Sinusite/terapia , Sinusite/diagnóstico , Pólipos Nasais/induzido quimicamente , Pólipos Nasais/terapia , Aspirina/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Doença Crônica
2.
Iran J Allergy Asthma Immunol ; 21(5): 512-523, 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36341560

RESUMO

Aspirin-exacerbated respiratory disease (AERD) is a chronic inflammatory disease. It is defined by asthma, chronic rhinosinusitis with nasal polyposis, and a hypersensitivity reaction to aspirin or nonsteroidal anti-inflammatory drugs. Aspirin desensitization (AD) has been confirmed as an effective treatment to control AERD inflammation through the modulation of immune responses. We aimed to review AERD with an overview of the epidemiology, pathophysiology, and treatment. We also discussed the effect of AD on immunological markers involved in AERD pathogenesis. A search of electronic databases on AERD was performed. We included five randomized clinical trials (RCTs) on AD. We also searched databases for recent studies that investigated the effect of AD on the immunological mechanisms of AERD. RCTs have demonstrated the therapeutic effectiveness of AD on the patients' quality of life, asthma symptom score, inhaled and oral steroid use, forced expiratory volume in 1 sec (FEV1), and inflammatory mediators. The clinical benefits of AD can occur though the regulation of innate and adaptive immune responses that are involved in the pathogenesis of AERD. In addition to the valuable effects of AD in RCTs, some side effects such as gastrointestinal bleeding, asthma exacerbation, or rash have been reported that should be considered for reaching an optimal protocol for AD.


Assuntos
Asma Induzida por Aspirina , Asma , Pólipos Nasais , Sinusite , Humanos , Asma Induzida por Aspirina/terapia , Pólipos Nasais/terapia , Pólipos Nasais/complicações , Dessensibilização Imunológica , Aspirina/efeitos adversos , Asma/tratamento farmacológico , Doença Crônica
3.
Lancet ; 400(10363): 1597-1606, 2022 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335970

RESUMO

BACKGROUND: Peptic ulcers in patients receiving aspirin are associated with Helicobacter pylori infection. We aimed to investigate whether H pylori eradication would protect against aspirin-associated ulcer bleeding. METHODS: We conducted a randomised, double-blind, placebo-controlled trial (Helicobacter Eradication Aspirin Trial [HEAT]) at 1208 primary care centres in the UK, using routinely collected clinical data. Eligible patients were aged 60 years or older who were receiving aspirin at a daily dose of 325 mg or less (with four or more 28-day prescriptions in the past year) and had a positive C13 urea breath test for H pylori at screening. Patients receiving ulcerogenic or gastroprotective medication were excluded. Participants were randomly assigned (1:1) to receive either a combination of oral clarithromycin 500 mg, metronidazole 400 mg, and lansoprazole 30 mg (active eradication), or oral placebo (control), twice daily for 1 week. Participants, their general practitioners and health-care providers, and the research nurses, trial team, adjudication committee, and analysis team were all masked to group allocation throughout the trial. Follow-up was by scrutiny of electronic data in primary and secondary care. The primary outcome was time to hospitalisation or death due to definite or probable peptic ulcer bleeding, and was analysed by Cox proportional hazards methods in the intention-to-treat population. This trial is registered with EudraCT, 2011-003425-96. FINDINGS: Between Sept 14, 2012, and Nov 22, 2017, 30 166 patients had breath testing for H pylori, 5367 had a positive result, and 5352 were randomly assigned to receive active eradication (n=2677) or placebo (n=2675) and were followed up for a median of 5·0 years (IQR 3·9-6·4). Analysis of the primary outcome showed a significant departure from proportional hazards assumptions (p=0·0068), requiring analysis over separate time periods. There was a significant reduction in incidence of the primary outcome in the active eradication group in the first 2·5 years of follow-up compared with the control group (six episodes adjudicated as definite or probable peptic ulcer bleeds, rate 0·92 [95% CI 0·41-2·04] per 1000 person-years vs 17 episodes, rate 2·61 [1·62-4·19] per 1000 person-years; hazard ratio [HR] 0·35 [95% CI 0·14-0·89]; p=0·028). This advantage remained significant after adjusting for the competing risk of death (p=0·028) but was lost with longer follow-up (HR 1·31 [95% CI 0·55-3·11] in the period after the first 2·5 years; p=0·54). Reports of adverse events were actively solicited; taste disturbance was the most common event (787 patients). INTERPRETATION: H pylori eradication protects against aspirin-associated peptic ulcer bleeding, but this might not be sustained in the long term. FUNDING: National Institute for Health and Care Research Health Technology Assessment.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Helicobacter , Úlcera Péptica , Humanos , Idoso , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/complicações , Aspirina/efeitos adversos , Temperatura Alta , Úlcera Péptica Hemorrágica/induzido quimicamente , Úlcera Péptica Hemorrágica/prevenção & controle , Úlcera Péptica/prevenção & controle , Claritromicina/efeitos adversos , Atenção Primária à Saúde , Prevenção Primária , Quimioterapia Combinada , Antibacterianos/efeitos adversos
4.
Sci Rep ; 12(1): 16591, 2022 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-36198683

RESUMO

Helicobacter pylori (H. pylori) screening and treatment is recommended for patients on chronic aspirin (ASA) therapy to reduce the risk of gastrointestinal bleeding. Coronary artery disease patients requiring combination antithrombotic therapy (dual antiplatelet therapy; DAPT, or dual pathway inhibition; DPI) are at an even higher risk of GI bleeding. Therefore, we aimed to evaluate the prevalence of H. pylori among patients referred for angiography and likely to receive DAPT or DPI. This single-center prospective observational study recruited patients undergoing coronary angiography and with the possibility of requiring DAPT or DPI. All included patients underwent H. pylori serology testing. Multivariable logistic regression was performed to determine predictors of seropositivity. 195 patients were included in the analysis. Mean age was 67 years, 50% had known prior CAD, and 49% underwent coronary intervention. H. pylori serology was positive in 36%. Chronic kidney disease (odds ratio [OR] 2.76; 95% confidence interval [CI] 1.24 to 6.15; p = 0.01) and chronic obstructive pulmonary disease (OR 2.52; 95% CI 1.14 to 5.55; p = 0.02) history were independent predictors of H. pylori seropositivity. Given the clinically significant prevalence of H. pylori seropositivity among patients referred for angiography, systematic screening strategies and eradication of H. pylori could significantly reduce the incidence of GI bleeding in patients requiring DAPT or DPI.


Assuntos
Helicobacter pylori , Intervenção Coronária Percutânea , Idoso , Aspirina/efeitos adversos , Angiografia Coronária , Estudos Transversais , Quimioterapia Combinada , Fibrinolíticos , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Prevalência , Fatores de Risco , Resultado do Tratamento
5.
Trials ; 23(1): 857, 2022 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-36203169

RESUMO

BACKGROUND: For the design and analysis of clinical trials with time-to-event outcomes, the Cox proportional hazards model and the logrank test have been the cornerstone methods for many decades. Increasingly, the key assumption of proportionality-or time-fixed effects-that underpins these methods has been called into question. The availability of novel therapies with new mechanisms of action and clinical trials of longer duration mean that non-proportional hazards are now more frequently encountered. METHODS: We compared several regression-based methods to model time-dependent treatment effects. For illustration purposes, we used selected endpoints from a large, community-based clinical trial of low dose daily aspirin in older persons. Relative and absolute estimands were defined, and analyses were conducted in all participants. Additional exploratory analyses were undertaken by selected subgroups of interest using interaction terms in the regression models. DISCUSSION: In the trial with median 4.7 years follow-up, we found evidence for non-proportionality and a time-dependent treatment effect of aspirin on cancer mortality not previously reported in trial findings. We also found some evidence of time-dependence to an aspirin by age interaction for major adverse cardiovascular events. For other endpoints, time-fixed treatment effect estimates were confirmed as appropriate. CONCLUSIONS: The consideration of treatment effects using both absolute and relative estimands enhanced clinical insights into potential dynamic treatment effects. We recommend these analytical approaches as an adjunct to primary analyses to fully explore findings from clinical trials.


Assuntos
Aspirina , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Humanos , Modelos de Riscos Proporcionais , Fatores de Tempo
6.
Circ Cardiovasc Qual Outcomes ; 15(10): e008995, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36193750

RESUMO

BACKGROUND: Patients with chronic kidney disease (CKD) on dialysis (CKD G5D) have worse cardiovascular outcomes than patients with advanced nondialysis CKD (CKD G4-5: estimated glomerular filtration rate <30 mL/[min·1.73m2]). Our objective was to evaluate the relationship between achievement of cardiovascular guideline-directed medical therapy (GDMT) goals and clinical outcomes for CKD G5D versus CKD G4-5. METHODS: This was a subgroup analysis of ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease) participants with CKD G4-5 or CKD G5D and moderate-to-severe myocardial ischemia on stress testing. Exposures included dialysis requirement at randomization and GDMT goal achievement during follow-up. The composite outcome was all-cause mortality or nonfatal myocardial infarction. Individual GDMT goal (smoking cessation, systolic blood pressure <140 mm Hg, low-density lipoprotein cholesterol <70 mg/dL, statin use, aspirin use) trajectory was modeled. Percentage point difference was estimated for each GDMT goal at 24 months between CKD G5D and CKD G4-5, and for association with key predictors. Probability of survival free from all-cause mortality or nonfatal myocardial infarction by GDMT goal achieved was assessed for CKD G5D versus CKD G4-5. RESULTS: A total of 415 CKD G5D and 362 CKD G4-5 participants were randomized. Participants with CKD G5D were less likely to receive statin (-6.9% [95% CI, -10.3% to -3.7%]) and aspirin therapy (-3.0% [95% CI, -5.6% to -0.6%]), with no difference in other GDMT goal attainment. Cumulative exposure to GDMT achieved during follow-up was associated with reduction in all-cause mortality or nonfatal myocardial infarction (hazard ratio, 0.88 [95% CI, 0.87-0.90]; per each GDMT goal attained over 60 days), irrespective of dialysis status. CONCLUSIONS: CKD G5D participants received statin or aspirin therapy less often. Cumulative exposure to GDMT goals achieved was associated with lower incidence of all-cause mortality or nonfatal myocardial infarction in participants with advanced CKD and chronic coronary disease, regardless of dialysis status. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01985360.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Infarto do Miocárdio , Insuficiência Renal Crônica , Humanos , Diálise Renal/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Infarto do Miocárdio/epidemiologia , LDL-Colesterol , Aspirina/efeitos adversos
7.
JACC Cardiovasc Interv ; 15(19): 1948-1960, 2022 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-36202563

RESUMO

BACKGROUND: There is a paucity of data regarding the safety and efficacy of different antiplatelet regimens according to standardized body mass index (BMI) categories. OBJECTIVES: The aim of this study was to investigate bleeding and ischemic outcomes according to BMI in the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) trial. METHODS: The TWILIGHT trial randomized high-risk patients to ticagrelor plus aspirin or ticagrelor plus placebo at 3 months after percutaneous coronary intervention. In this secondary analysis, patients were stratified by standard BMI categories, as recommended by the European Society of Cardiology Working Group on Thrombosis (normal weight [BMI 18.5-24.99 kg/m2], overweight [BMI 25-29.99 kg/m2], and obese [BMI ≥30 kg/m2]) and by median BMI, as prespecified in the protocol. RESULTS: Among 7,038 patients randomized and with available BMI, 1,807 (25.7%) were normal weight, 2,927 (41.6%) were overweight, and 2,304 (32.7%) were obese. In normal-weight, overweight, and obese patients, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced the primary endpoint of Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (normal weight: HR: 0.48 [95% CI: 0.32-0.73]; overweight: HR: 0.57 [95% CI: 0.41-0.78]; obese: HR: 0.63 [95% CI: 0.44-0.91]; P for interaction = 0.627), without any increase in the composite ischemic endpoint of all-cause death, myocardial infarction, or stroke (normal weight: HR: 1.36 [95% CI: 0.84-2.19]; overweight: HR: 0.92 [95% CI: 0.63-1.35]; obese: HR: 0.84 [95% CI: 0.56-1.25]; P for interaction = 0.290). These findings were consistent with the prespecified analysis by median BMI. CONCLUSIONS: Among high-risk patients undergoing percutaneous coronary intervention, ticagrelor monotherapy, compared with ticagrelor plus aspirin, reduced bleeding events without any increase in ischemic risk across different BMI categories.


Assuntos
Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária , Aspirina/efeitos adversos , Índice de Massa Corporal , Quimioterapia Combinada , Hemorragia/induzido quimicamente , Humanos , Obesidade/complicações , Obesidade/diagnóstico , Sobrepeso/induzido quimicamente , Sobrepeso/complicações , Sobrepeso/diagnóstico , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/efeitos adversos , Ticagrelor/efeitos adversos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 101(42): e31158, 2022 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-36281144

RESUMO

BACKGROUND: To evaluate the efficacy and safety of dual antiplatelet regimens after coronary drug-eluting stenting by network meta-analysis (NMA). METHODS: PubMed, The Cochrane Library, Embase, and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different dual antiplatelet regimens after coronary drug-eluting stenting from inception to September 1st, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Stata 16.0 software was used for NMA. RESULTS: A total of 27 RCTs involving 79,880 patients were included. The results of NMA: in terms of myocardial infarction (MI), other 3 interventions were higher than the long-term dual antiplatelet therapy (L-DAPT) (the standard dual antiplatelet therapy [Std-DAPT] [odds ratio [OR] = 1.82, 95%confidence interval [CI]: 1.49-2.21), the aspirin monotherapy after short-term dual antiplatelet therapy (S-DAPT + As) (OR = 2.06, 95%CI: 1.57-2.70), the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (S-DAPT + P2Y12) (OR = 1.71, 95%CI: 1.29-2.28)]. In terms of stent thrombosis, other 3 interventions were higher than L-DAPT [Std-DAPT (OR = 2.18, 95%CI: 1.45-3.28), S-DAPT + As (OR = 2.32, 95%CI: 1.52-3.54), S-DAPT + P2Y12 (OR = 2.31, 95%CI: 1.22-4.36)]. There was no statistically significant difference among the 4 interventions in prevention of stroke and all-cause mortality (P > .05). In terms of cardiovascular and cerebrovascular adverse events, other 3 interventions were higher than L-DAPT (Std-DAPT [OR = 1.28, 95%CI: 1.12-1.45], S-DAPT + As [OR = 1.27, 95%CI: 1.09-1.48], S-DAPT + P2Y12 [OR = 1.24, 95%CI: 1.01-1.52]). In terms of safety, bleeding rate of other 3 interventions were lower than L-DAPT (Std-DAPT [OR = 0.67, 95%CI: 0.52-0.85], S-DAPT + As [OR = 0.51, 95%CI: 0.39-0.66], S-DAPT + P2Y12 [OR = 0.36, 95%CI: 0.26-0.49]). Two interventions were lower than L-DAPT (S-DAPT + As [OR = 0.77, 95%CI: 0.65-0.90], S-DAPT + P2Y12 [OR = 0.54, 95%CI: 0.44-0.66]). S-DAPT + As was higher than L-DAPT (OR = 1.42, 95%CI: 1.10-1.83). CONCLUSIONS: S-DAPT + P2Y12 has the lowest bleeding risk, while L-DAPT has the highest bleeding risk. In the outcome of MI, stent thrombosis, and cardiovascular and cerebrovascular adverse events, L-DAPT has the best efficacy. In the outcome of stroke and all-cause mortality, the 4 interventions were equally effective.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infecções Sexualmente Transmissíveis , Acidente Vascular Cerebral , Trombose , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Metanálise em Rede , Aspirina/efeitos adversos , Infarto do Miocárdio/etiologia , Stents/efeitos adversos , Trombose/etiologia , Acidente Vascular Cerebral/complicações , Quimioterapia Combinada , Resultado do Tratamento
9.
Medicine (Baltimore) ; 101(42): e28243, 2022 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-36281191

RESUMO

RATIONALE: Eptifibatide is an antiplatelet agent used in the medical management of acute coronary syndrome. Although multiple studies did not reveal a significant association between eptifibatide and the development of thrombocytopenia, recent case reports brought attention to this relatively rare side effect. PATIENT CONCERNS: We report a 61 years old male with acute coronary syndrome who underwent primary coronary intervention. DIAGNOSIS AND INTERVENTION: The patient developed acute profound thrombocytopenia following eptifibatide administration. Following prompt offending drug discontinuation, the platelet counts recovered, without clinical sequelae or the need for platelet transfusion. Dual antiplatelet therapy with aspirin and clopidogrel was resumed after platelet count normalization. OUTCOMES: The patient had a normal platelet count and no bleeding events on follow-up after three months upon discharge. CONCLUSION: Eptifibatide, a glycoprotein IIa/IIIb inhibitor used in the management of acute coronary syndrome, can induce acute, profound thrombocytopenia that can have significant morbidity in patients. This case highlights this relatively rare side effect and the importance of monitoring blood counts and observing for any signs of bleeding or thrombosis that might occur in such patients.


Assuntos
Síndrome Coronariana Aguda , Trombocitopenia , Humanos , Masculino , Pessoa de Meia-Idade , Eptifibatida/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Clopidogrel/efeitos adversos , Síndrome Coronariana Aguda/tratamento farmacológico , Trombocitopenia/diagnóstico , Aspirina/efeitos adversos , Hemorragia/induzido quimicamente , Glicoproteínas/efeitos adversos
10.
Expert Rev Gastroenterol Hepatol ; 16(10): 981-992, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36245097

RESUMO

BACKGROUND AND OBJECTIVE: Current guidelines recommend aspirin maintenance for high-risk endoscopic procedures. Some Asian physicians noticed increasing postoperative bleeding in patients taking aspirin. We aimed to explore whether risk of postoperative hemorrhage due to aspirin differs in the East and the West. METHODS: PubMed, EMBASE and Cochrane library database were systematically reviewed. We only included trials that met our criteria. RESULTS: There is significant association between aspirin and postoperative bleeding (P < 0.001), especially in Eastern population (data from Japan, Korea, Turkey and China, P < 0.001). Result from the West (data from America, Canada and Australia) had no statistical significance (P = 0.07). For Easterners, aspirin increased bleeding risk after endoscopic submucosal dissection (ESD) and endoscopic sphincterotomy (EST). For Westerners, aspirin increased bleeding risk post endoscopic mucosal resection (EMR). For patients undergoing ESD, those who continued to receive aspirin had higher bleeding risk than patients who interrupted it for more than 7 days (P = 0.005). CONCLUSION: Aspirin increases risk of postoperative hemorrhage. Easterners are more likely to suffer from bleeding after aspirin administration than Westerners. Stopping aspirin for more than 7 days may be advisable to control bleeding post ESD for patients with low risk of thrombosis.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Humanos , Aspirina/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Estudos Retrospectivos , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/epidemiologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Neoplasias Gástricas/cirurgia , Mucosa Gástrica
11.
Clin Appl Thromb Hemost ; 28: 10760296221124902, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36112808

RESUMO

BACKGROUND: Dual antiplatelet therapy (DAPT) is recommended over single antiplatelet therapy (SAPT) in patients following coronary artery bypass grafting (CABG). The compilation of evidence has focused on the efficacy of DAPT to limit risk of graft occlusion, however the safety, especially in the on-pump CABG population, is less well described. The aim of this study was to assess the safety of DAPT versus SAPT after on-pump CABG. METHODS: This was a single-center, retrospective cohort analysis of adult patients following isolated on-pump CABG between January 2012 and December 2019 not on oral anticoagulation at discharge. The primary endpoint was occurrence of a composite bleeding event identified by pre-specified ICD codes. Secondary endpoints consisted of 30-day and 1-year mortalities along with individual bleeding components. RESULTS: Of the 2341 patients included 1250 patients were in the SAPT arm and 1091 patients in the DAPT arm. The study populations differed by age, prior MI, PAD, and CHF status/stage. Bleeding events occurred in a total of 70 patients (3.0%), with 36 patients (2.9%) in the SAPT arm and 34 patients (3.1%) in the DAPT arm (P = .74). 30-day (SAPT 0.7% vs DAPT 0.4%) and 1-year (SAPT 3.3% vs DAPT 2.3%) mortality were not significantly different between groups. The most frequent bleed event was in the gastrointestinal tract. CONCLUSION: In this study, DAPT was not associated with an increase in composite bleeding compared to SAPT. This study could reduce the barrier to prescribing of DAPT given previous efficacy data.


Assuntos
Aspirina , Inibidores da Agregação Plaquetária , Anticoagulantes/uso terapêutico , Aspirina/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Quimioterapia Combinada , Hemorragia/etiologia , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos Retrospectivos
13.
Eur J Clin Pharmacol ; 78(11): 1801-1811, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36121499

RESUMO

BACKGROUND AND PURPOSE: Uncertainty remains regarding the impact of enteric-coated aspirin (EC-ASA) on secondary prevention of ischemic stroke compared to plain aspirin (P-ASA). Hence, this study was designed to investigate the effect of EC formulation on ASA response via evaluating thromboxane B2 (TXB2) levels in patients with suspected or newly diagnosed stroke. METHODS: A prospective cohort study on suspected or newly diagnosed ischemic stroke patients who are aspirin-naive was conducted. Patients were received either EC aspirin or plain aspirin for at least 3 days. The primary outcome was the proportion of aspirin non-responsiveness between two groups (level of residual serum TXB2 associated with elevated thrombotic risk (< 99.0% inhibition or TXB2 > 3.1 ng/ml) within 72 h after three daily aspirin doses, while secondary outcomes were the incidence of early gastrointestinal tract (GIT) bleeding with the various aspirin preparations. (Trial registration: Clinicaltrials.gov NCT04330872 registered on 02 April 2020). RESULTS: Of 42 patients, ischemic strokes were confirmed in both P-ASA (81%) and EC-ASA (67%) arms. ASA non-responsiveness showed no significant difference between the two formulations (P-ASA vs. EC-ASA; 28.6% vs 23.8%; P = 0.726). Univariate and multivariate logistic regression analysis showed that patients treated with EC-ASA were more likely to have a lower rate of non-responders compared to P-ASA (unadjusted OR 0.78; 95% CI 0.20, 3.11); with the risk highest in type 2 diabetic patients with HBA1c > 6.5% (adjusted OR 6; 95% CI 1.02, 35.27; P = 0.047). No incidence of GIT bleeding observed throughout the study. CONCLUSION: A significant proportion of ASA non-responsiveness was recorded regardless of ASA formulation administered. The increased risk of ASA non-responsiveness in diabetic patients needs further exploration by larger prospective studies.


Assuntos
Aspirina , AVC Isquêmico , Aspirina/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Hemoglobina A Glicada , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos Prospectivos , Tromboxano B2
14.
G Ital Cardiol (Rome) ; 23(10): 746-760, 2022 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-36169125

RESUMO

In the context of secondary prevention, the efficacy of aspirin in reducing cardiovascular events is widely acknowledged. However, its use for primary prevention is still debated because of uncertain data regarding the risk-benefit ratio. Despite the reduction in atherothrombotic events, almost all randomized clinical trials and meta-analyses have failed to demonstrate a net clinical benefit, as cardiovascular outcome improvement was counterbalanced by increased bleeding. We have, however, to acknowledge that, within the population eligible for primary prevention, cardiovascular risk distribution is extremely heterogeneous. Using data obtained from the most recent trials, we performed a meta-regression of benefits and risks associated with aspirin related to 10-year risk of major adverse cardiovascular events (MACEs). We are thus proposing a tailored approach to find the proper patient category to treat with aspirin in primary prevention. In patients <70 years old with an optimal control of cardiovascular risk factors, physicians should carefully evaluate individual MACE risk and make a therapeutic decision accordingly, also considering bleeding risk and patient preference. The results of net clinical benefit analysis of aspirin therapy suggest that patients with intermediate-high cardiovascular risk (10-year MACE risk >10%) without a prohibitive bleeding risk may represent the target population, since in these patients the reduction in atherothrombotic events overcomes the induced excess of bleeding. Antiplatelet therapy benefits also appear to be amplified by the simultaneous administration of gastroprotective agents and treatment of other cardiovascular risk factors, such as dyslipidemia and hypertension.


Assuntos
Aspirina , Doenças Cardiovasculares , Idoso , Aspirina/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/prevenção & controle , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Inibidores da Agregação Plaquetária , Prevenção Primária/métodos , Medição de Risco
15.
J Assoc Physicians India ; 70(8): 11-12, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36082731

RESUMO

Globally, the prevalence of chronic coronary syndrome (CCS) increases with age. In India, there is a rapidly growing burden of coronary artery disease (CAD), which has become the leading cause of morbidity and mortality. Despite recommended medical therapy, patients with CCS are still at risk of ischemic events. Currently, dual antiplatelet therapy (DAPT) is recommended in the form of aspirin and a P2Y12 inhibitor or low dose rivaroxaban in patients with stable CAD and/or peripheral artery disease (PAD). A low dose of rivaroxaban in combination with aspirin is a promising approach; however, for patients who might benefit the most, it still remains a challenge. Clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial and prespecified subgroups of COMPASS trials suggesting that the addition of rivaroxaban to aspirin was associated with a significantly lower risk of ischemic events, mortality, and tolerable bleeding profile in patients with CCS and high-risk factors. This combination is cost-effective and generally well tolerated in patients with CAD and/or PAD, as well as patients with CCS and multimorbidity or high-risk populations.


Assuntos
Doença da Artéria Coronariana , Doença Arterial Periférica , Aspirina/efeitos adversos , Quimioterapia Combinada , Inibidores do Fator Xa/efeitos adversos , Humanos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação Plaquetária/efeitos adversos , Rivaroxabana/efeitos adversos
16.
J Clin Neurosci ; 105: 66-72, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36113244

RESUMO

Clinical significance of increased clopidogrel response measured by VerifyNow P2Y12 assay is unclear; management guidelines are lacking in the context of neuroendovascular intervention. Our objective was to assess whether increased clopidogrel response predicts complications from endovascular aneurysm treatment requiring dual antiplatelet therapy. A single-institution, 9-year retrospective study of patients undergoing endovascular treatments for ruptured and unruptured aneurysms requiring aspirin and clopidogrel was conducted. Patients were grouped according to preoperative platelet inhibition in response to clopidogrel measured by the VerifyNow P2Y12 assay (VNP; P2Y12 reactivity units, PRU). Demographic and clinical features were compared across groups. Hemorrhagic complication rates (intracranial, major extracranial, minor extracranial) and thromboembolic complications (in-stent stenosis, stroke/transient ischemic attack) were compared, controlling for potential confounders and multiple comparisons. Data were collected from 284 patients across 317 procedures. Pre-operative VNP assays identified 9 % Extreme Responders (PRU ≤ 15), 13 % Hyper-Responders (PRU 16-60), 62 % Therapeutic Responders (PRU 61-214), 16 % Hypo-Responders (PRU ≥ 215). Increased response to clopidogrel was associated with increased risk of any hemorrhagic complication (≤60 PRU vs > 60 PRU; 39 % vs 24 %, P = 0.050); all intracranial hemorrhages occurred in patients with PRU > 60. Thromboembolic complications were similar between therapeutic and subtherapeutic patients (<215 PRU vs ≥ 215 PRU; 15 % vs 16 %, P = 0.835). Increased preoperative clopidogrel response is associated with increased rate of extracranial hemorrhagic complications in endovascular aneurysm treatments. Hyper-responders (16-60 PRU) and Extreme Responders (≤15 PRU) were not associated with intracranial hemorrhagic or thrombotic complications. Hypo-responders who underwent adjustment of antiplatelet therapy and neurointerventions did not experience higher rates of complications.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Intracraniano , Tromboembolia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Aspirina/efeitos adversos , Clopidogrel/uso terapêutico , Procedimentos Endovasculares/efeitos adversos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Intracraniano/cirurgia , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos Retrospectivos , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia , Resultado do Tratamento
17.
Sci Rep ; 12(1): 14887, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36050471

RESUMO

The use of low-dose aspirin in older adults is increasing as is the prevalence of osteoporosis. Aspirin has been shown in numerous studies to affect bone metabolism. However, there is no clear link between low-dose aspirin use and bone mineral density (BMD). This study examined differences in bone mineral density between low-dose aspirin users and non-aspirin users in adults aged 50-80 years. We conducted a cross-sectional study of 15,560 participants who participated in the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020. We used a multivariate logistic regression model to evaluate the relationship between low-dose aspirin and femoral neck BMD, femoral total BMD, intertrochanteric BMD, and the first lumbar vertebra BMD (L1 BMD) in patients aged 50 to 80 years. A total of 1208 (Group 1: femoral neck BMD, total femur BMD, and intertrochanter BMD) and 1228 (Group 2: L1 BMD) adults were included in this study. In both group 1 and group 2, BMD was higher in the low-dose aspirin group than in the non-aspirin group (Total femur BMD ß = 0.019, 95% CI 0.004-0.034; Femoral neck BMD ß = 0.017, 95% CI 0.002-0.032; Intertrochanter BMD ß = 0.025, 95% CI 0.007-0.043; L1 BMD ß = 0.026, 95% CI 0.006-0.046). In subgroup analyses stratified by gender, this positive association existed in both gender after adjusting for confounders. On subgroup analyses stratified by age, this positive association existed in three different age groups after adjusting for confounders. To test whether the effect of low-dose aspirin on BMD was affected by gender and age, the interaction P value was greater than 0.05. These findings from a human study looking into the relationship between low-dose aspirin use and BMD suggest that regular low-dose aspirin may be associated with a higher BMD. The association between low-dose aspirin and BMD did not differ by age group or gender.


Assuntos
Densidade Óssea , Colo do Fêmur , Absorciometria de Fóton , Idoso , Aspirina/efeitos adversos , Estudos Transversais , Colo do Fêmur/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Inquéritos Nutricionais
19.
Nutrition ; 103-104: 111799, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36096055

RESUMO

OBJECTIVES: Sweet potato (Ipomoea batatas) is accredited as a functional food because of its nutraceutical compounds. These dietary components may help heal lesions and ulcer scars in the stomach. This research was designed to examine the antioxidant and antiulcerative potential of sweet potato (red skin, white flesh) against aspirin-induced gastric ulcers in a rabbit model. METHODS: Sweet potato samples were analyzed for in vitro analysis, such as 2,2-diphenyl-1-picrylhydrazyl assay, total phenolic content, and total flavonoid content. In a bioefficacy study, rabbits were divided into five groups (n = 6) in which G0 received the standard diet only, G1 150 mg/kg aspirin, G2 20 mg/kg omeprazole, G3 1000 mg/kg aqueous extract of sweet potato, and G4 1000 mg/kg ethanolic extract of sweet potato. After completion of the trial, the animals were decapitated and examined for antiulcer parameters, serum analysis, and hematologic parameters. RESULTS: The mean values for 2,2-diphenyl-1-picrylhydrazyl, total phenolic content, and total flavonoid content were 57%, 927 mg gallic acid equivalent/100 g, and 1901 µg quercetin equivalent/g, respectively. The values for gastric volume, acid output, ulcer scores and index, total oxidant status, white blood cell count, and lymphocyte count were increased significantly (P < 0.05) for the positive control group compared with G2, G3, and G4. Gastric pH and body weight at the end of the experiment were significantly reduced for the positive control group (P < 0.05) compared with G2, G3, and G4. Histology test results of gastric tissues in G1 depicted severe epithelial damage compared with G2, G3, and G4. CONCLUSIONS: The results for the antiulcer parameters ascertained the antiulcer activity of sweet potato in aspirin-induced gastric ulcer models.


Assuntos
Ipomoea batatas , Úlcera Gástrica , Animais , Coelhos , Aspirina/efeitos adversos , Flavonoides/farmacologia , Flavonoides/uso terapêutico , Ipomoea batatas/química , Fenóis , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/tratamento farmacológico , Úlcera
20.
Paediatr Drugs ; 24(6): 603-655, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36053397

RESUMO

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in infants, children, and adolescents worldwide; however, despite sufficient evidence of the beneficial effects of NSAIDs in children and adolescents, there is a lack of comprehensive data in infants. The present review summarizes the current knowledge on the safety and efficacy of various NSAIDs used in infants for which data are available, and includes ibuprofen, dexibuprofen, ketoprofen, flurbiprofen, naproxen, diclofenac, ketorolac, indomethacin, niflumic acid, meloxicam, celecoxib, parecoxib, rofecoxib, acetylsalicylic acid, and nimesulide. The efficacy of NSAIDs has been documented for a variety of conditions, such as fever and pain. NSAIDs are also the main pillars of anti-inflammatory treatment, such as in pediatric inflammatory rheumatic diseases. Limited data are available on the safety of most NSAIDs in infants. Adverse drug reactions may be renal, gastrointestinal, hematological, or immunologic. Since NSAIDs are among the most frequently used drugs in the pediatric population, safety and efficacy studies can be performed as part of normal clinical routine, even in young infants. Available data sources, such as (electronic) medical records, should be used for safety and efficacy analyses. On a larger scale, existing data sources, e.g. adverse drug reaction programs/networks, spontaneous national reporting systems, and electronic medical records should be assessed with child-specific methods in order to detect safety signals pertinent to certain pediatric age groups or disease entities. To improve the safety of NSAIDs in infants, treatment needs to be initiated with the lowest age-appropriate or weight-based dose. Duration of treatment and amount of drug used should be regularly evaluated and maximum dose limits and other recommendations by the manufacturer or expert committees should be followed. Treatment for non-chronic conditions such as fever and acute (postoperative) pain should be kept as short as possible. Patients with chronic conditions should be regularly monitored for possible adverse effects of NSAIDs.


Assuntos
Flurbiprofeno , Cetoprofeno , Adolescente , Lactente , Criança , Humanos , Meloxicam , Naproxeno/uso terapêutico , Celecoxib/efeitos adversos , Ibuprofeno , Diclofenaco , Cetorolaco , Ácido Niflúmico , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Anti-Inflamatórios , Doença Crônica , Dor/tratamento farmacológico
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