Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin

Total Page:16

File Type:pdf, Size:1020Kb

Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin Thrombosis Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin Guest Editors: Christian Doutremepuich, Jawad fareed, Jeanine M. Walenga, Jean-Marc Orgogozo, and Marie Lordkipanidzé Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin Thrombosis Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin Guest Editors: Christian Doutremepuich, Jawad fareed, Jeanine M. Walenga, Jean-Marc Orgogozo, and Marie Lordkipanidze´ Copyright © 2012 Hindawi Publishing Corporation. All rights reserved. This is a special issue published in “Thrombosis.” All articles are open access articles distributed under the Creative Commons Attribu- tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Board Louis M. Aledort, USA Thomas Kickler, USA Johannes Oldenburg, Germany David Bergqvist, Sweden S. P. Kunapuli, USA Graham F. Pineo, Canada Francis J. Castellino, USA Jose A. Lopez, USA Domenico Prisco, Italy M. Cattaneo, Italy C. A. Ludlam, Uk Karin Przyklenk, USA Beng Hock Chong, Australia Nageswara Madamanchi, USA Ashwini Koneti Rao, USA Frank C. Church, USA Martyn Mahaut-Smith, UK F. R. Rickles, USA Giovanni de Gaetano, Italy P. M . Ma nnu cc i, Ita ly Evqueni Saenko, USA David H. Farrell, USA Osamu Matsuo, Japan Paolo Simioni, Italy Alessandro Gringeri, Italy Keith R. McCrae, USA C. Arnold Spek, The Netherlands Jolan´ Harsfalvi,´ Hungary Paulette S. Mehta, USA Perumal Thiagarajan, USA Debra A. Hoppensteadt, USA Joost Meijers, The Netherlands Cees Vermeer, The Netherlands Omer Iqbal, USA Edith Nutescu, USA Ted Wun, USA Contents Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin, Christian Doutremepuich Volume 2012, Article ID 626289, 1 page Aspirin Prophylaxis for the Prevention of Thrombosis: Expectations and Limitations, GunduH.R.RaoandJawadFareed Volume 2012, Article ID 104707, 9 pages The Role of Dermcidin Isoform 2: A Two-Faceted Atherosclerotic Risk Factor for Coronary Artery Disease and the Effect of Acetyl Salicylic Acid on It, Rajeshwary Ghosh, Uttam K. Maji, Rabindra Bhattacharya, and Asru K. Sinha Volume 2012, Article ID 987932, 9 pages Paradoxical Effect of Aspirin, Christian Doutremepuich, Omar Aguejouf, Vanessa Desplat, and Francisco X. Eizayaga Volume 2012, Article ID 676237, 4 pages Variability in the Responsiveness to Low-Dose Aspirin: Pharmacological and Disease-Related Mechanisms, Bianca Rocca and Giovanna Petrucci Volume 2012, Article ID 376721, 11 pages Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease, Yuxiang Dai and Junbo Ge Volume 2012, Article ID 245037, 7 pages Thrombotic Events Associated to Aspirin Therapy, Christian Doutremepuich, Omar Aguejouf, Vanessa Desplat, Dominique Duprat, and Francisco X. Eizayaga Volume 2012, Article ID 247363, 5 pages Aspirin: Pharmacology and Clinical Applications, Enma V. Paez Espinosa, John P. Murad, and Fadi T. Khasawneh Volume 2012, Article ID 173124, 15 pages Beneficial Effect of Ultra-Low-Dose Aspirin in Platelet Activity Alterations and Haemorrhage Observed in Experimental Portal Hypertension, F. X. Eizayaga, O. Aguejouf, V. Desplat, and C. Doutremepuich Volume 2012, Article ID 430460, 6 pages Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?, Wolfgang Losche,¨ Janina Boettel, Bjorn¨ Kabisch, Johannes Winning, Ralf A. Claus, and Michael Bauer Volume 2012, Article ID 720254, 8 pages Hindawi Publishing Corporation Thrombosis Volume 2012, Article ID 626289, 1 page doi:10.1155/2012/626289 Editorial Thrombosis and Aspirin: Clinical Aspect, Aspirin in Cardiology, Aspirin in Neurology, and Pharmacology of Aspirin Christian Doutremepuich Laboratoire d’H´ematologie, Universit´e Victor Segalen Bordeaux 2, 146 Rue L´eoSaignat, 33076 Bordeaux Cedex, France Correspondence should be addressed to Christian Doutremepuich, [email protected] Received 1 July 2012; Accepted 1 July 2012 Copyright © 2012 Christian Doutremepuich. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Acetyl salicylic acid or aspirin is one of the most famous The work of Losche¨ et al. (Jena University Hospital, Jena, drugs in the world. Aspirin has been increasingly used for Germany) on the problem of the reduction of mortality in prevention of cardiovascular events and is, particularly in critically ill patients also demonstrates the effectiveness of recent decades, the most used nonsteroidal anti-inflam- antiplatelet drugs to prevent organ failure. matory drug. The three experimental studies from the laboratory of Thus, it was necessary to have several contributions to Doutremepuich concern the paradoxical action of aspirin precise the interest and the side effects of aspirin in cardiol- used at different dosages. These different effects can explain ogy, pharmacology, and neurology. the thrombosis observed in clinical practice after aspirin A general review on aspirin pharmacology was made discontinuation. The question could be also: what is the by Espinosa et al. (Western University of Health Sciences, effect of a drug at ultralow dose? Pomona, CA, USA). This review article helps to understand In conclusion, this special issue can represent a “state of the role of platelets in primary hemostasis and atherothrom- art” on aspirin and thrombosis with new hypotheses of work. bosis, the use of aspirin in the prevention, and treatment of cardiovascular diseases. Acknowledgments In the review article by B. Rocca and G. Petrucci (Catholic University School of Medicine, Rome, Italy), they have Thanks are due to Professors J. Fareed, J. M. Walenga, J.- detailed the phenomenon of variability in the responsiveness M. Orgogozo, and M. Lordkipanidze´ for their valuable to low-dose aspirin and reported the explanations of this real collaboration that enabled the realization of this work. problem in patients. Thanks are also due to D. Duprat, V. Desplat, F. X. Eizayaga, The clinical use of aspirin in treatment and prevention and O. Aguejouf for their technical assistance. of cardiovascular diseases was the subject of the work of Y. Dai and J. Ge (Fudan University, Shanghai, China). In Christian Doutremepuich this paper, the authors review the different clinical situations when aspirin is administered. The use of aspirin for prevention of thrombosis was clearly discussed by G. H. R. Rao and J. Fareed (University of Minnesota, Minneapolis, MN and Loyola University Medical Center, Maywood, IL, USA). The special work on the role of dermcidin isoform 2 by Ghosh et al. (Calcutta, India) completes the two clinical papers. Hindawi Publishing Corporation Thrombosis Volume 2012, Article ID 104707, 9 pages doi:10.1155/2012/104707 Research Article Aspirin Prophylaxis for the Prevention of Thrombosis: Expectations and Limitations GunduH.R.Rao1 and Jawad Fareed2 1 Lillehei Heart Institute, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA 2 Departments of Pathology and Pharmacology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA Correspondence should be addressed to Jawad Fareed, [email protected] Received 16 June 2011; Accepted 31 October 2011 Academic Editor: Christian Doutremepuich Copyright © 2012 G. H. R. Rao and J. Fareed. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Platelets play a very important role in the pathogenesis of acute vascular events leading to thrombosis of the coronary and cerebral arteries. Blockage of these arteries leading to regional ischemia of heart and brain tissues precipitate heart attacks and stroke. Acetyl salicylic acid (Aspirin) has been the drug of choice for over half a century for the primary and secondary prophylaxis of thrombotic events. In spite of its extensive use as an antiplatelet drug for the prevention of vascular thrombosis, there is considerable concern about the degree of protection it offers, to patients under aspirin therapy. In this paper, we explain the phenomenon of aspirin resistance, discuss the limitations of aspirin therapy, and suggest methods to monitor “at-risk” individuals. Ability to monitor and determine at risk patients will provide opportunities for the clinicians to customize antiplatelet therapies. 1. Introduction to cause platelet aggregation and secretion. Aspirin is a specific inhibitor of cyclooxygenase (COX-1) and prevents Role of platelets in the pathogenesis of thrombosis and stroke the formation of pro-aggregatory PG endoperoxides. is well documented [1]. There is a great need for developing Data from large number of clinical studies have demon- ff specific and e ective antiplatelet drugs for modulating strated that at any given risk for the development of acute platelet function. A thorough understanding of the signaling vascular events, irrespective of the disease state, aspirin at mechanisms involved in the regulation of platelet function low-to-medium concentration is as effective as any other will facilitate the development of better antiplatelet drugs. drug in reducing the risks
Recommended publications
  • Aspirin for the Primary Prevention of Cardiovascular Events: a Summary of the Evidence
    Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence Michael Hayden, MD; Michael Pignone, MD, MPH; Christopher Phillips, MD; Cynthia Mulrow, MD, MSc Epidemiolgy power to precisely estimate major harms such as gastrointestinal bleeding and hemorrhagic stroke.4,5 Cardiovascular disease (CVD), including ischemic coronary heart disease (CHD), stroke, and The results of these first 2 randomized, controlled peripheral vascular disease, is the leading cause of trials were available to the members of the U.S. morbidity and mortality in the United States.1 In Preventive Services Task Force at the time of their 1997, the age-adjusted mortality rate due to 1996 recommendation.4,5 At that time, the Task coronary heart disease, cerebrovascular disease, and Force found insufficient evidence to recommend for atherosclerotic disease was 194 per 100,000 people, or against routine aspirin prophylaxis for the equating to more than 500,000 deaths per year.1 The primary prevention of myocardial infarction in estimated direct and indirect costs of CHD and asymptomatic people.6 stroke were $145 billion for 1999.2 Two additional large primary prevention trials Although the benefit of aspirin for patients with were published in 1998, and another was reported in known CVD is well established,3 the question of January 2001.7, 8, 9 In light of the new evidence, the whether aspirin reduces the risk of CVD in people U.S. Preventive Services Task Force sought to without known CVD is controversial. Two early reassess the value of aspirin for the primary randomized trials of aspirin in healthy men, the U.S.
    [Show full text]
  • Venous Thromboembolism
    CLINICAL PRACTICE GUIDELINES MOH/P/PAK/264.13(GU) Prevention and Treatment of Venous Thromboembolism VTE Ministry of Health Malaysian Society of National Heart Association Academy of Medicine Malaysia Haematology of Malaysia Malaysia STATEMENT OF INTENT These guidelines are meant to be a guide for clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not necessarily ensure the best outcome in every case. Every health care provider is responsible for the management options available locally. REVIEW OF THE GUIDELINES These guidelines were issued in 2013 and will be reviewed in 2017 or sooner if new evidence becomes available. Electronic version available on the following website: http://www.haematology.org.my DISCLOSURE STATEMENT The panel members had completed disclosure forms. None held shares in pharmaceutical firms or acted as consultants to such firms (details are available upon request from the CPG Secretariat). SOURCES OF FUNDING The development of the CPG on Prevention and Treatment of Venous Thromboembolism was supported via unrestricted educational grant from Bayer Healthcare Pharmaceuticals. The funding body has not influenced the development of the guidelines. ISBN 978-967-12100-0-0 9 789671 210000 August 2013 © Ministry of Health Malaysia 01 GUIDELINES DEVELOPMENT The development group for these guidelines consists of Haematologist, Cardiologist, Neurologist, Obstetrician & Gynaecologist, Vascular Surgeon, Orthopaedic Surgeon, Anaesthesiologist, Pharmacologist and Pharmacist from the Ministry of Health Malaysia, Ministry of Higher Education Malaysia and the Private sector. Literature search was carried out at the following electronic databases: International Health Technology Assessment website, PUBMED, MEDLINE, Cochrane Database of Systemic Reviews (CDSR), Journal full teXt via OVID search engine and Science Direct.
    [Show full text]
  • Proefschrift-Banne-Nemeth.Pdf
    Stellingen behorende bij het proefschrift Venous thrombosis following lower-leg cast immobilization and knee arthroscopy From a population-based approach to individualized therapy 1. A prophylactic regimen of low-molecular-weight-heparin for eight days after knee arthroscopy or during the complete immobilization period in patients with casting of the lower leg is not efective for the prevention of symptomatic venous thromboembolism. -this thesis- 2. For patients with a history of venous thromboembolism who are undergoing surgery or are treated with a lower leg cast, the risk of recurrent venous thromboembolism is high. -this thesis- 3. Estimating the risk of venous thromboembolism risk following lower leg cast immobilization or following knee arthroscopy is feasible by using a risk prediction model. -this thesis- 4. A targeted approach, by identifying high-risk patients who may beneft from a higher dose or longer duration of thromboprophylactic therapy, is a promising next step to prevent symptomatic VTE following lower leg cast immobilization or knee arthroscopy. -this thesis- 5. The best treatment strategy to prevent symptomatic venous thromboembolism following lower leg cast immobilization or following knee arthroscopy is yet to be determined. 6. Prognostic models are meant to assist and not to replace clinicians’ decisions. Accurate estimation of risks of outcomes can enhance informed decision making with the patient. -Adapted from PLoS Med 10(2): e1001381- 7. The frst developed prediction model is not the last. 8. Voor de dagelijkse klinische praktijk is het essentieel dat onderzoeksresultaten op de juiste manier worden geïnterpreteerd en toegepast. Om dit te waarborgen is een intensievere samenwerking tussen epidemiologen en dokters aan te raden.
    [Show full text]
  • The Approach to Thrombosis Prevention Across the Spectrum of Philadelphia-Negative Classic Myeloproliferative Neoplasms
    Review The Approach to Thrombosis Prevention across the Spectrum of Philadelphia-Negative Classic Myeloproliferative Neoplasms Steffen Koschmieder Department of Medicine (Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation), Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, D-52074 Aachen, Germany; [email protected]; Tel.: +49-241-8080981; Fax: +49-241-8082449 Abstract: Patients with myeloproliferative neoplasm (MPN) are potentially facing diminished life expectancy and decreased quality of life, due to thromboembolic and hemorrhagic complications, progression to myelofibrosis or acute leukemia with ensuing signs of hematopoietic insufficiency, and disturbing symptoms such as pruritus, night sweats, and bone pain. In patients with essential thrombocythemia (ET) or polycythemia vera (PV), current guidelines recommend both primary and secondary measures to prevent thrombosis. These include acetylsalicylic acid (ASA) for patients with intermediate- or high-risk ET and all patients with PV, unless they have contraindications for ASA use, and phlebotomy for all PV patients. A target hematocrit level below 45% is demonstrated to be associated with decreased cardiovascular events in PV. In addition, cytoreductive therapy is shown to reduce the rate of thrombotic complications in high-risk ET and high-risk PV patients. In patients with prefibrotic primary myelofibrosis (pre-PMF), similar measures are recommended as in those with ET. Patients with overt PMF may be at increased risk of bleeding and thus require a more individualized approach to thrombosis prevention. This review summarizes the thrombotic Citation: Koschmieder, S. The risk factors and primary and secondary preventive measures against thrombosis in MPN. Approach to Thrombosis Prevention across the Spectrum of Keywords: myeloproliferative neoplasms (MPN); polycythemia vera (PV); essential thrombocythemia Philadelphia-Negative Classic (ET); primary myelofibrosis (PMF); thrombosis; prevention; antiplatelet agents; anticoagulation; cy- Myeloproliferative Neoplasms.
    [Show full text]
  • Final Program
    In Memoriam: Final Program XXV Congress of the International Society on Thrombosis and Haemostasis and 61st Annual SSC Meeting June 20 – 25, 2015 Toronto, Canada www.isth2015.org 1 Final Program Table of Contents 3 Venue and Contacts 5 Invitation and Welcome Message 12 ISTH 2015 Committees 24 Congress Support 25 Sponsors and Exhibitors 27 ISTH Awards 32 ISTH Society Information 37 Program Overview 41 Program Day by Day 55 SSC and Educational Program 83 Master Classes and Career Mentorship Sessions 87 Nurses Forum 93 Scientific Program, Monday, June 22 94 Oral Communications 1 102 Plenary Lecture 103 State of the Art Lectures 105 Oral Communications 2 112 Abstract Symposia 120 Poster Session 189 Scientific Program, Tuesday, June 23 190 Oral Communications 3 198 Plenary Lecture 198 State of the Art Lectures 200 Oral Communications 4 208 Plenary Lecture 209 Abstract Symposia 216 Poster Session 285 Scientific Program, Wednesday, June 24 286 Oral Communications 5 294 Plenary Lecture 294 State of the Art Lectures 296 Oral Communications 6 304 Abstract Symposia 311 Poster Session 381 Scientific Program, Thursday, June 25 382 Oral Communications 7 390 Plenary Lecture 390 Abstract Symposia 397 Highlights of ISTH 399 Exhibition Floor Plan 402 Exhibitor List 405 Congress Information 406 Venue Plan 407 Congress Information 417 Social Program 418 Toronto & Canada Information 421 Transportation in Toronto 423 Future ISTH Meetings and Congresses 2 427 Authors Index 1 Thank You to Everyone Who Supported the Venue and Contacts 2014 World Thrombosis Day
    [Show full text]
  • A First in Class Treatment for Thrombosis Prevention. a Phase I
    Journal of Cardiology and Vascular Medicine Research Open Access A First in Class Treatment for Thrombosis Prevention. A Phase I study with CS1, a New Controlled Release Formulation of Sodium Valproate 1,2* 2 3 2 1,2 Niklas Bergh , Jan-Peter Idström , Henri Hansson , Jonas Faijerson-Säljö , Björn Dahlöf 1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Cereno Scientific AB, Gothenburg, Sweden 3 Galenica AB, Malmö, Sweden *Corresponding author: Niklas Bergh, The Wallenberg Laboratory for Cardiovascular Research Sahlgrenska University Hospi- tal Bruna Stråket 16, 413 45 Göteborg, Tel: +46 31 3421000; E-Mail: [email protected] Received Date: June 11, 2019 Accepted Date: July 25, 2019 Published Date: July 27, 2019 Citation: Niklas Bergh (2019) A First in Class Treatment for Thrombosis Prevention? A Phase I Study With Cs1, a New Con- trolled Release Formulation of Sodium Valproate. J Cardio Vasc Med 5: 1-12. Abstract Several lines of evidence indicate that improving fibrinolysis by valproic acid may be a fruitful strategy for throm- bosis prevention. This study investigated the safety, pharmacokinetics, and effect on biomarkers for thrombosis of CS1, a new advanced controlled release formulation of sodium valproate designed to produce optimum valproic acid concen- trations during the early morning hours, when concentrations of plasminogen activator inhibitor (PAI)-1 and the risk of thrombotic events is highest. Healthy volunteers (n=17) aged 40-65 years were randomized to receive single doses of one of three formulations of CS1 (FI, FII, and FIII). The CS1 FII formulation showed the most favorable pharmacokinetics and was chosen for multiple dosing.
    [Show full text]
  • State-Of-The-Art Thrombosis Prevention and Treatment
    FOREWORD State-of-the-art thrombosis prevention and treatment antagonists are used for longer periods of primary ‘Pulmonary embolism is a and secondary prophylaxis of thrombosis. leading cause of death in Heparins, especially unfractionated, have draw- cancer patients and the risk for backs, including the need for subcutaneous venous thromboembolism is injections and the risk for heparin-induced thrombocytopenia and osteoporosis on long- significantly increased in patients term use. The heparin derivatives requires bind- with solid tumors and ing to antithrombin in order to exert their anti- hematological malignancies.’ coagulant properties. Vitamin K antagonists have a narrow thera- Benjamin Brenner Thrombosis is the leading cause of death in peutic range that necessitates frequent monitoring Rambam Health Care developed countries, with arterial thrombosis of the prothrombin time. The pharmacogenetics Campus, Department of presenting as myocardial infarction, stroke or of the vitamin K epoxide reductase and CYP219 Hematology and Bone Marrow Transplantation, peripheral arterial occlusion. Venous thrombo- genes may be helpful to better define the dose and Haifa, Israel embolism (VTE) is a major cause of mortality the risk for bleeding on vitamin K antagonists [5]. Tel.: +972 4854 3520 worldwide, despite some variations in prevalence These limitations led to the development of Fax: +972 4854 3886 of the disease [1]. While the incidence of VTE numerous new antithrombotic agents during the E-mail: b_brenner@ rambam.health.gov.il increases with aging, it is the leading cause of past decade, and to an ongoing effort by the vascular morbidity in young adults. industry to develop novel anticoagulants with A multitude of risk factors can contribute to improved efficacy and safety profile and better presentation of VTE [2].
    [Show full text]
  • Annals of Internal Medicine
    16 August 2005 Volume 143 Issue 4 Articles gfedc Warfarin plus Aspirin after Myocardial Infarction or the Acute Coronary Syndrome: Meta-Analysis with Estimates of Risk and Benefit Michael B. Rothberg, Carmel Celestin, Louis D. Fiore, Elizabeth Lawler, and James R. Cook After acute coronary syndromes, warfarin plus aspirin was associated with fewer myocardial infarctions, ischemic strokes, and revascularization procedures. Warfarin was associated with an increase in major bleeding, but mortality did not differ. For patients who are at low or intermediate risk for bleeding, the cardiovascular benefits of warfarin outweigh the bleeding risks.(241-264) gfedc Clinical Outcomes and Cost-Effectiveness of Strategies for Managing People at High Risk for Diabetes David M. Eddy, Leonard Schlessinger, and Richard Kahn The authors used a novel decision model to estimate the long-term outcomes and costs of care when patients with impaired glucose tolerance use metformin or enroll in a lifestyle modification program. Although the program used in the Diabetes Prevention Program prevented diabetes in some patients and delayed it in others, the authors found that it was not cost-effective for health plans to implement.(265-273) gfedc A Prognostic Index for Systemic AIDS-Related Non-Hodgkin Lymphoma Treated in the Era of Highly Active Antiretroviral Therapy Mark Bower, Brian Gazzard, Sundhiya Mandalia, Tom Newsom-Davis, Christina Thirlwell, Tony Dhillon, Anne Marie Young, Tom Powles, Andrew Gaya, Mark Nelson, and Justin Stebbing The International Prognostic Index predicts death in non-Hodgkin lymphoma, including AIDS-related lymphoma before highly active antiretroviral therapy (HAART). Since the advent of HAART, the prognosis has improved for AIDS-related non-Hodgkin lymphoma.
    [Show full text]
  • Prevention of Deep Vein Thrombosis in Orthopedic Surgery
    112 EUROPEAN JOURNAL OF MEDICAL RESEARCH March 30, 2004 Eur J Med Res (2004) 9: 112-118 © I. Holzapfel Publishers 2004 PREVENTION OF DEEP VEIN THROMBOSIS IN ORTHOPEDIC SURGERY S. Eichinger, P.A. Kyrle Department of Internal Medicine I, Div. of Hematology and Hemostasis, Medical University of Vienna, Austria Abstract: In the absence of thromboprophylaxis, have been identified (e.g., prolonged immobility, venous thromboembolism (VTE) affects about 50 obesity, previous thromboembolism, cancer) [1], to 80% of the patients after total hip replacement but proper stratification of patients in those who (THR), total knee replacement (TKR), or hip frac- will become symptomatic and those who will not, ture surgery. Since stratification of patients in is thus far impossible. Thus, primary thrombo- those who will become symptomatic and those prophylaxis should be provided to all patients who will not, is not possible, primary high risk undergoing major orthopedic surgery of the lower thromboprophylaxis should be provided to all pa- extremity. tients undergoing major orthopedic surgery of the Over the years various non-pharmacologic and lower extremity. Various non-pharmacologic and pharmacologic thromboprophylactic measures pharmacologic thromboprophylactic measures have been evaluated. Pharmacologic thrombo- have been evaluated. With regard to pharmacolog- prophylaxis has been revolutionized by the intro- ic thromboprophylaxis unfractionated heparin duction of heparin. Meanwhile unfractionated has now almost completely been replaced by low heparin (UFH) has now almost completely been molecular weight heparin (LMWH) for VTE pro- replaced by low molecular weight heparin phylaxis. The use of acetylsalicylic acid for throm- (LMWH) for VTE prophylaxis. boprophylaxis in patients undergoing major or- thopedic surgery of the lower extremities is not LMWH VERSUS UFH recommended.
    [Show full text]
  • Role of Antiplatelet Therapies in Preventing Atherothrombosis Mohamed Z Khalil* Consultant Cardiologist, Saudi British Hospital, Riyadh, Saudi Arabia
    & Throm gy b o o l e o t m Journal of Hematology & a b o m Khalil, J Hematol Thromb Dis 2013, 1:2 l e i c H D f DOI: 10.4172/2329-8790.1000108 o i s l e a Thromboembolic Diseases ISSN: 2329-8790 a n s r e u s o J Review Article Open Access Role of Antiplatelet Therapies in Preventing Atherothrombosis Mohamed Z Khalil* Consultant Cardiologist, Saudi British Hospital, Riyadh, Saudi Arabia Abstract Platelets exhibit a major role in development and progression of atherothrombosis. The normal function of platelets is to secure hemostasis at sites of vascular injuries. Abnormal endovascular structure may result in excessive platelet function with consequence of progressive or acute reduction in vascular lumen and cessation of blood flow. Despite succeeding in averting bleeding, total occlusion of a vessel leads to inevitable ischemia with eventual cell death upon lack of blood supply clinically manifesting as myocardial infarction in coronary vessels, cerebral infarction (stroke) in cerebral vessels, or peripheral gangrene in peripheral arterial disease. Antiplatelets long have been used to halt the process of atherothrombosis preventing further tissue damage at the expense of bleeding as well as other side effects. In this review, the role of antiplatelets in primary and secondary prevention of thrombotic events is explored in light of evidence based clinical practice. Keywords: Antiplatelets; Atherothrombosis; Myocardial infarction; remains to be a difficult task to physicians administering antiplatelet Stroke; Acute coronary syndrome therapies. Furthermore, combination of antiplatelet therapies is another concern increasing the risk for bleeding while achieving modest platelet Introduction inhibition as well as modest reduction of thrombotic events [30-35].
    [Show full text]
  • Antithrombotic Therapy in Hypertension: a Cochrane Systematic Review
    Journal of Human Hypertension (2005) 19, 185–196 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Antithrombotic therapy in hypertension: a Cochrane Systematic review DC Felmeden and GYH Lip Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK Although elevated systemic blood pressure (BP) results on one large trial, ASA taken for 5 years reduced in high intravascular pressure, the main complications myocardial infarction (ARR, 0.5%, NNT 200 for 5 years), of hypertension are related to thrombosis rather than increased major haemorrhage (ARI, 0.7%, NNT 154), and haemorrhage. It therefore seemed plausible that use of did not reduce all cause mortality or cardiovascular antithrombotic therapy may be useful in preventing mortality. In two small trials, warfarin alone or in thrombosis-related complications of elevated BP. The combination with ASA did not reduce stroke or coronary objectives were to conduct a systematic review of the events. Glycoprotein IIb/IIIa inhibitors as well as ticlopi- role of antiplatelet therapy and anticoagulation in dine and clopidogrel have not been sufficiently eval- patients with BP, to address the following hypotheses: uated in patients with elevated BP. To conclude for (i) antiplatelet agents reduce total deaths and/or major primary prevention in patients with elevated BP, anti- thrombotic events when compared to placebo or other platelet therapy with ASA cannot be recommended active treatment; and (ii) oral anticoagulants reduce total since the magnitude of benefit, a reduction in myocar- deaths and/or major thromboembolic events when dial infarction, is negated by a harm of similar magni- compared to placebo or other active treatment.
    [Show full text]
  • Aspirin: Past, Present and Future
    n COLLEGE LECTURES Aspirin: past, present and future Peter C Elwood ABSTRACT – Many folk remedies used since pre- white willow tree, dried ‘upon the outside of a baker’s historic times have depended upon salicylates for oven for more than three months’. He described the their effect. One hundred years ago aspirin was effective treatment with this powder of ‘fever in over formulated from salicylic and acetic acids. It was 50 patients suffering from various agues’. the first drug to be synthesised and its formula- Salicylic acid seems to have been first synthesised tion is regarded as the foundation of the modern from carbolic acid around 1859 by a German chemist pharmaceutical industry. and it came to be widely used for the relief of pain The benefit of low-dose aspirin as a prophy- and fever. Because of its irritant action on the This article is lactic after a thrombotic event was first reported stomach, efforts were then made by chemists to find based on the 25 years ago. Its use after coronary or cerebral a form or a derivative of salicylic acid which could be Milroy Lecture thrombosis is virtually mandatory, unless there better tolerated. In 1897 Felix Hoffman, a chemist given at the Royal College of are signs of intolerance. A ‘loading dose’ of working in a laboratory owned by Friedrich Bayer in Physicians on 26 soluble aspirin should be given on first contact Elberfeld, Germany, and stimulated by earlier work June 2000 by with a patient who may be suffering from on acetylation, formulated a pure and stable form of Peter C Elwood myocardial infarction.
    [Show full text]