scholarly journals Long-term residual cardiovascular risk after acute coronary syndrome: antithrombotic treatment options

2021 ◽  
Author(s):  
D. R. P. P. Chan Pin Yin ◽  
J. M. ten Berg
Keyword(s):  
Low Dose ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Residual Risk ◽  
Antithrombotic Treatment ◽  
Residual Cardiovascular Risk ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Dose Aspirin ◽  
Low Dose Aspirin

AbstractThe residual risk of patients surviving until 1 year after acute coronary syndromes (ACS) is still high, despite secondary prevention. The cornerstone of treatment of patients with ACS is dual antiplatelet therapy (DAPT) consisting of low-dose aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) for 12 months, or less in those patients at higher risk for bleeding. To reduce the residual risk beyond 1 year in those patients not at high bleeding risk who tolerated DAPT and did not suffer an (ischaemic or bleeding) event would intuitively mean to prolong DAPT. However, prolonged DAPT always comes at the cost of more bleeding. Therefore, assessing both ischaemic and bleeding risk in these patients at 1 year after ACS is crucial. In addition, another antithrombotic treatment consisting of low-dose rivaroxaban combined with low-dose aspirin has been shown to reduce ischaemic events. In this review, we describe residual thrombotic risk at 1 year after ACS, evaluate the evidence for antithrombotic options beyond 1 year and provide a practical guide to determine which patients would benefit the most from these therapies.

Increased Thromboxane Biosynthesis in Essential Thrombocythemia

1995 ◽  
Vol 74 (05) ◽  
pp. 1225-1230 ◽  
Author(s):  
Bianca Rocca ◽  
Giovanni Ciabattoni ◽  
Raffaele Tartaglione ◽  
Sergio Cortelazzo ◽  
Tiziano Barbui ◽  
...  
Keyword(s):  
Platelet Count ◽  
Platelet Activation ◽  
Essential Thrombocythemia ◽  
Therapeutic Strategy ◽  
Low Dose ◽  
Thrombotic Risk ◽  
Dose Aspirin ◽  
Gender And Age ◽  
Low Dose Aspirin

SummaryIn order to investigate the in vivo thromboxane (TX) biosynthesis in essential thromboeythemia (ET), we measured the urinary exeretion of the major enzymatic metabolites of TXB2, 11-dehydro-TXB2 and 2,3-dinor-TXB2 in 40 ET patients as well as in 26 gender- and age-matched controls. Urinary 11-dehydro-TXB2 was significantly higher (p <0.001) in thrombocythemic patients (4,063 ± 3,408 pg/mg creatinine; mean ± SD) than in controls (504 ± 267 pg/mg creatinine), with 34 patients (85%) having 11-dehydro-TXB2 >2 SD above the control mean. Patients with platelet number <1,000 × 109/1 (n = 25) had significantly higher (p <0.05) 11 -dehydro-TXB2 excretion than patients with higher platelet count (4,765 ± 3,870 pg/mg creatinine, n = 25, versus 2,279 ± 1,874 pg/mg creatinine, n = 15). Average excretion values of patients aging >55 was significantly higher than in the younger group (4,784 ± 3,948 pg/mg creatinine, n = 24, versus 2,405 ± 1,885 pg/mg creatinine, n = 16, p <0.05). Low-dose aspirin (50 mg/d for 7 days) largely suppressed 11-dehydro-TXB2 excretion in 7 thrombocythemic patients, thus suggesting that platelets were the main source of enhanced TXA2 biosynthesis. The platelet count-corrected 11-dehydro-TXB2 excretion was positively correlated with age (r = 0.325, n = 40, p <0.05) and inversely correlated with platelet count (r = -0.381, n = 40, p <0.05). In addition 11 out of 13 (85%) patients having increased count-corrected 11-dehydro-TXB2 excretion, belonged to the subgroup with age >55 and platelet count <1,000 × 1099/1. We conclude that in essential thrombocythemia: 1) enhanced 11-dehydro-TXB2 excretion largely reflects platelet activation in vivo;2) age as well as platelet count appear to influence the determinants of platelet activation in this setting, and can help in assessing the thrombotic risk and therapeutic strategy in individual patients.

Low-Dose Aspirin Use Spikes Bleeding Risk

2012 ◽  
Vol 13 (10) ◽  
pp. 4-5
Author(s):  
Elizabeth Mechcatie
Keyword(s):  
Low Dose ◽  
Bleeding Risk ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Resistance to low-dose aspirin therapy among patients with acute coronary syndrome in relation to associated risk factors

2009 ◽  
Vol 37 (6) ◽  
pp. 630-636 ◽  
Author(s):  
M. M. Salama ◽  
A.-R. Mohamed Morad ◽  
M. A. Saleh ◽  
N. A. Sabri ◽  
M. M. Zaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Coronary Syndrome ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Associated Risk Factors

Low-Dose Aspirin Use Spiked Bleeding Risk

2012 ◽  
Vol 42 (11) ◽  
pp. 3
Author(s):  
ELIZABETH MECHCATIE
Keyword(s):  
Low Dose ◽  
Bleeding Risk ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Bleeding Risk with Long-Term Low-Dose Aspirin: A Systematic Review of Observational Studies

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0160046 ◽  
Author(s):  
Luis A. García Rodríguez ◽  
Mar Martín-Pérez ◽  
Charles H. Hennekens ◽  
Peter M. Rothwell ◽  
Angel Lanas
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Low Dose ◽  
Bleeding Risk ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals A randomized double-blind trial of 3 aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia

Blood ◽  
2020 ◽  
Vol 136 (2) ◽  
pp. 171-182 ◽  
Author(s):  
Bianca Rocca ◽  
Alberto Tosetto ◽  
Silvia Betti ◽  
Denise Soldati ◽  
Giovanna Petrucci ◽  
...  
Keyword(s):  
Essential Thrombocythemia ◽  
Low Dose ◽  
Double Blind Trial ◽  
Double Blind ◽  
Thrombotic Risk ◽  
Once Daily ◽  
Blind Trial ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Cox 1

Abstract Essential thrombocythemia (ET) is characterized by abnormal megakaryopoiesis and enhanced thrombotic risk. Once-daily low-dose aspirin is the recommended antithrombotic regimen, but accelerated platelet generation may reduce the duration of platelet cyclooxygenase-1 (COX-1) inhibition. We performed a multicenter double-blind trial to investigate the efficacy of 3 aspirin regimens in optimizing platelet COX-1 inhibition while preserving COX-2–dependent vascular thromboresistance. Patients on chronic once-daily low-dose aspirin (n = 245) were randomized (1:1:1) to receive 100 mg of aspirin 1, 2, or 3 times daily for 2 weeks. Serum thromboxane B2 (sTXB2), a validated biomarker of platelet COX-1 activity, and urinary prostacyclin metabolite (PGIM) excretion were measured at randomization and after 2 weeks, as primary surrogate end points of efficacy and safety, respectively. Urinary TX metabolite (TXM) excretion, gastrointestinal tolerance, and ET-related symptoms were also investigated. Evaluable patients assigned to the twice-daily and thrice-daily regimens showed substantially reduced interindividual variability and lower median (interquartile range) values for sTXB2 (ng/mL) compared with the once-daily arm: 4 (2.1-6.7; n = 79), 2.5 (1.4-5.65, n = 79), and 19.3 (9.7-40; n = 85), respectively. Urinary PGIM was comparable in the 3 arms. Urinary TXM was reduced by 35% in both experimental arms. Patients in the thrice-daily arm reported a higher abdominal discomfort score. In conclusion, the currently recommended aspirin regimen of 75 to 100 once daily for cardiovascular prophylaxis appears to be largely inadequate in reducing platelet activation in the vast majority of patients with ET. The antiplatelet response to low-dose aspirin can be markedly improved by shortening the dosing interval to 12 hours, with no improvement with further reductions (EudraCT 2016-002885-30).

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