Aspirin Data
Life Flow One
The Solution For Heart Disease
by
Karl Loren
- Results for your query on June 13, 1999:
- Search all fields for: death
- Words in title only: aspirin
- Published in 1997 through 1999
- Only select references with abstracts available
- Show references published in English only
Documents: 1 to 30 of 30
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NLM database Documents
Record 1 from database: MEDLINE
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- Title
- Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for
the prevention of pre-eclampsia and its complications.
- Author
- Rotchell YE; Cruickshank JK; Gay MP; Griffiths J; Stewart A; Farrell B;
Ayers S; Hennis A; Grant A; Duley L; Collins R
- Address
- Faculty of Medical Sciences, University of the West Indies, Queen Elizabeth
Hospital, Barbados.
- Source
- Br J Obstet Gynaecol, 1998 Mar, 105:3, 286-92
- Abstract
- OBJECTIVE: To determine whether prophylactic, low dose controlled-release
aspirin improves outcome for pregnant women and their babies in Barbados.
DESIGN: Randomised placebo-controlled trial. SETTING: The Queen Elizabeth
Hospital, Barbados. POPULATION: All women attending antenatal clinics between 12
and 32 weeks of gestation were eligible, if without specific contraindications
to aspirin and unlikely to deliver immediately. METHODS: Randomisation was
computer-generated in the antenatal clinic; 1822 women were allocated to receive
75 mg controlled-release aspirin and 1825 matching placebo. MAIN OUTCOME
MEASURES: Proteinuric pre-eclampsia, other pregnancy-induced hypertension,
pregnancy duration, birthweight, stillbirths and neonatal deaths, major neonatal
events. RESULTS: All but three women from each group were followed up
successfully. Forty-four percent were primigravid, and 8% had previous obstetric
complications. There were no significant differences between the allocated
treatment groups in the incidence of proteinuric pre-eclampsia (40 [2.2%] of
those allocated aspirin, compared with 46 [2.5%] allocated placebo), of preterm
delivery (255 [14.0%] vs 270 [14.8%]), of birthweight < 1500 g (32 [1.7%] vs
33 [1.8%]) or of stillbirth and neonatal death (44 [2.4%] vs 38 [2.1%]). Aspirin
was not associated with excess risk of maternal or fetal bleeding. CONCLUSIONS:
The results of this study in Barbados do not support the routine use of low dose
aspirin for prevention of pre-eclampsia or its complications, confirming results
of previous large trials in other settings.
- Language of Publication
- English
- Unique Identifier
- 98194182
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- MeSH Heading (Major)
- Aspirin|*AD; Platelet Aggregation Inhibitors|*AD; Pre-Eclampsia|*PC
- MeSH Heading
- Adult; Barbados|EP; Birth Weight; Delayed-Action Preparations; Female; Fetal
Death; Gestational Age; Hospitalization; Human; Infant; Infant Mortality;
Infant, Newborn; Pregnancy; Pregnancy Outcome; Prenatal Care; Support, Non-U.S.
Gov't; Time Factors
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0306-5456
- Country of Publication
- ENGLAND
Record 2 from database: MEDLINE
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- Title
- Aspirin poisoning during pregnancy: increased fetal sensitivity.
- Author
- Palatnick W; Tenenbein M
- Address
- Department of Family Medicine, University of Manitoba and Children's
Hospital, Winnipeg, Canada.
- Source
- Am J Perinatol, 1998 Jan, 15:1, 39-41
- Abstract
- Descriptions of salicylate poisoning during pregnancy are rare and unique
features of perinatal physiology predict an increased sensitivity of the fetus
to aspirin poisoning. A 17-year-old, 37-week pregnant woman presented to the
hospital stating that she had ingested 50 aspirin tablets per day for 1 month in
an attempt to harm her baby and herself. Ultrasound showed fetal demise. Serum
salicylate was 620 mg/L with an anion gap of 22.6 and the following blood gases:
pO2 108 mm Hg, pCO2 15mm Hg, pH 7.34, and HCO3 8.8 mmol/L. She was successfully
treated with alkaline diuresis followed by hemodialysis. She spontaneously
delivered a macerated stillborn 2380-g fetus. Autopsy revealed diffuse petechiae
in the lungs, heart, thymus, and kidneys. Salicylic acid was found in the cord
blood, but quantification was not possible due to the small volume of the blood
sample. Our patient supports the hypothesis that the fetus is at greater risk
than the mother in salicylate poisoning during pregnancy. Consideration should
be given to emergent delivery of term or near-term, aspirin-poisoned fetuses.
- Language of Publication
- English
- Unique Identifier
- 98133833
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- MeSH Heading (Major)
- Anti-Inflammatory Agents, Non-Steroidal|BL/*PO; Aspirin|BL/*PO; Fetal
Death|*CI; Fetus|*DE
- MeSH Heading
- Adolescence; Blood Gas Analysis; Blood Glucose|AN; Case Report; Diuresis;
Female; Fetal Blood|CH; Hemodialysis; Human; Male; Pregnancy; Vitamin K|TU
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0735-1631
- Country of Publication
- UNITED STATES
Record 3 from database: MEDLINE
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- Title
- Interaction between enalapril and aspirin on mortality after acute
myocardial infarction: subgroup analysis of the Cooperative New Scandinavian
Enalapril Survival Study II (CONSENSUS II) [see comments]
- Author
- Nguyen KN; Aursnes I; Kjekshus J
- Address
- Department of Pharmacotherapeutics, University of Oslo, Norway.
- Source
- Am J Cardiol, 1997 Jan, 79:2, 115-9
- Abstract
- The use of angiotensin-converting enzyme (ACE) inhibitors early after an
acute myocardial infarction to reduce mortality has been studied in several
trials with inconsistent results. Aspirin (ASA) has become a well-documented
therapeutic adjunct in patients with coronary heart disease. Attention has
recently been focused on a possible interaction between ASA and ACE inhibitors.
We therefore reanalyzed data from the Cooperative New Scandinavian Enalapril
Survival Study II (CONSENSUS II) to find any evidence of differential effects of
the ACE inhibitor enalapril in subgroups defined by use of ASA at baseline.
Logistic regression tested the multiplicative interaction. We used Rothman
synergy index S, which would be equal to unity under additivity, and less than
unity when suggesting antagonism, to examine the postulated interaction with
departure from an additive model. Logistic regression showed that the
enalapril-ASA interaction term was a significant predictor of mortality at the
end of the study (p = 0.047), and was a borderline significant predictor of
mortality 30 days after randomization (p = 0.085). The Rothman synergy index S
was 0.66 (95% confidence interval 0.46 to 0.94) for mortality at the end of the
study, and 0.68 ( 0.44 to 1.04) for 30-day mortality, indicating antagonism
between enalapril and ASA with departure from an additive model. Thus, we found
evidence of enalapril-ASA interaction. The effect of enalapril was less
favorable among patients taking ASA than among patients not taking ASA at
baseline.
- Language of Publication
- English
- Unique Identifier
- 97336213
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- MeSH Heading (Major)
- Angiotensin-Converting Enzyme Inhibitors|AD/*TU; Anti-Inflammatory Agents,
Non-Steroidal|AD/AI/*TU; Aspirin|AD/AI/*TU; Enalapril|AD/AI/*TU; Myocardial
Infarction|*DT
- MeSH Heading
- Aged; Cause of Death; Confidence Intervals; Double-Blind Method; Drug
Interactions; Female; Follow-Up Studies; Forecasting; Heart Failure,
Congestive|PP; Human; Logistic Models; Male; Placebos; Recurrence; Retrospective
Studies; Scandinavia; Survival Rate; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0002-9149
- Country of Publication
- UNITED STATES
Record 4 from database: MEDLINE
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- Title
- Early outcome in acute ischemic stroke is not influenced by the prophylactic
use of low-dose aspirin.
- Author
- De Keyser J; Herroelen L; De Klippel N
- Address
- Department of Neurology, Academisch Ziekenhuis Groningen, The Netherlands.
j.h.a.de.keyser@med.rug.nl
- Source
- J Neurol Sci, 1997 Jan, 145:1, 93-6
- Abstract
- Aspirin reduces the occurrence of ischemic strokes. In some prophylactic
trials it was suggested that aspirin might also lessen stroke severity, and
hence improve outcome in patients sustaining an ischemic stroke. We examined
stroke severity (by using the Mathew scale) and early outcome (Barthel index and
mortality on day 21) in 91 patients with an acute (< 24 h) ischemic stroke in
the territory of the middle cerebral artery. Twenty-seven patients were taking
low-dose aspirin (100 or 200 mg/day) prior to their stroke, and 64 were not
using antiplatelet drugs. There were no significant differences in baseline
stroke severity, early (21 days) mortality or early disability between the two
groups. The results of this small study suggest that the use of low-dose aspirin
prior to an ischemic stroke does not influence the severity of that stroke and
early outcome.
- Language of Publication
- English
- Unique Identifier
- 97225765
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- MeSH Heading (Major)
- Aspirin|*AD; Cerebral Ischemia|CO/*DT/MO; Cerebrovascular
Disorders|*DT/ET/*PC
- MeSH Heading
- Aged; Cause of Death; Cerebral Hemorrhage|MO/RA; Comparative Study; Female;
Human; Male; Tomography, X-Ray Computed; Treatment Outcome
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0022-510X
- Country of Publication
- NETHERLANDS
Record 5 from database: MEDLINE
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- Title
- A comparison of aspirin plus tirofiban with aspirin plus heparin for
unstable angina. Platelet Receptor Inhibition in Ischemic Syndrome Management
(PRISM) Study Investigators [see comments]
- Address
-
- Source
- N Engl J Med, 1998 May, 338:21, 1498-505
- Abstract
- BACKGROUND: Activation of platelets is central to the pathophysiology of
unstable angina. We studied whether inhibition of the final common pathway for
platelet aggregation with tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor
antagonist, would improve clinical outcome in this condition. METHODS: In a
double-blind study, we randomly assigned 3232 patients who were already
receiving aspirin to additional treatment with intravenous tirofiban for 48
hours. The primary end point was a composite of death, myocardial infarction, or
refractory ischemia at 48 hours. RESULTS: The incidence of the composite end
point was 32 percent lower at 48 hours in the group that received tirofiban (3.8
percent, vs. 5.6 percent with heparin; risk ratio, 0.67; 95 percent confidence
interval, 0.48 to 0.92; P=0.01). Percutaneous revascularization was performed in
1.9 percent of the patients during the first 48 hours. At 30 days, the frequency
of the composite end point (with the addition of readmission for unstable
angina) was similar in the two groups (15.9 percent in the tirofiban group vs.
17.1 percent in the heparin group, P=0.34). There was a trend toward a reduction
in the rate of death or myocardial infarction with tirofiban (a rate of 5.8
percent, as compared with 7.1 percent in the heparin group; risk ratio, 0.80; 95
percent confidence interval, 0.61 to 1.05; P=0.11), and mortality was 2.3
percent, as compared with 3.6 percent in the heparin group (P=0.02). Major
bleeding occurred in 0.4 percent of the patients in both groups. Reversible
thrombocytopenia occurred more frequently with tirofiban than with heparin (1.1
percent vs. 0.4 percent, P=0.04). CONCLUSIONS: Tirofiban was generally well
tolerated and, as compared with heparin, reduced ischemic events during the
48-hour infusion period, during which revascularization procedures were not
performed. The incidence of refractory ischemia and myocardial infarction was
not reduced at 30 days, but mortality was lower among the patients given
tirofiban. Platelet inhibition with aspirin plus tirofiban may have a role in
the management of unstable angina.
- Language of Publication
- English
- Unique Identifier
- 98242979
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- MeSH Heading (Major)
- Angina, Unstable|*DT/MO; Aspirin|*TU; Fibrinolytic Agents|*TU; Heparin|*TU;
Platelet Aggregation Inhibitors|*TU; Platelet Glycoprotein GPIIb-IIIa
Complex|*AI; Tyrosine|*AA/TU
- MeSH Heading
- Aged; Comparative Study; Double-Blind Method; Drug Therapy, Combination;
Female; Human; Incidence; Infusions, Intravenous; Male; Middle Age; Myocardial
Infarction|EP/PC; Myocardial Ischemia|EP/PC; Proportional Hazards Models
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0028-4793
- Country of Publication
- UNITED STATES
Record 6 from database: MEDLINE
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- Title
- The International Stroke Trial (IST): a randomised trial of aspirin,
subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic
stroke. International Stroke Trial Collaborative Group [see comments]
- Address
-
- Source
- Lancet, 1997 May, 349:9065, 1569-81
- Abstract
- BACKGROUND: Only a few small trials have compared antithrombotic therapy
(antiplatelet or anticoagulant agents) versus control in acute ischaemic stroke,
and none has been large enough to provide reliable evidence on safety or
efficacy. METHODS: The International Stroke Trial (IST) was a large, randomised,
open trial of up to 14 days of antithrombotic therapy started as soon as
possible after stroke onset. The aim was to provide reliable evidence on the
safety and efficacy of aspirin and of subcutaneous heparin. Half the patients
were allocated unfractionated heparin (5000 or 12,500 IU bd [twice daily]), and
half were allocated "avoid heparin"; and, in a factorial design, half were
allocated aspirin 300 mg daily and half "avoid aspirin". The primary outcomes
were death within 14 days and death or dependency at 6 months. 19,435 patients
with suspected acute ischaemic stroke entering 467 hospitals in 36 countries
were randomised within 48 hours of symptom onset. RESULTS: Among
heparin-allocated patients, there were non-significantly fewer deaths within 14
days (876 [9.0%] heparin vs 905 [9.3%] no heparin), corresponding to 3 (SD 4)
fewer deaths per 1000 patients. At 6 months the percentage dead or dependent was
identical in both groups (62.9%). Patients allocated to heparin had
significantly fewer recurrent ischaemic strokes within 14 days (2.9% vs 3.8%)
but this was offset by a similar-sized increase in haemorrhagic strokes (1.2% vs
0.4%), so the difference in death or non-fatal recurrent stroke (11.7% vs 12.0%)
was not significant. Heparin was associated with a significant excess of 9 (SD
1) transfused or fatal extracranial bleeds per 1000. Compared with 5000 IU bd
heparin, 12,500 IU bd heparin was associated with significantly more transfused
or fatal extracranial bleeds, more haemorrhagic strokes, and more deaths or
non-fatal strokes within 14 days (12.6% vs 10.8%). Among aspirin-allocated
patients there were non-significantly fewer deaths within 14 days (872 [9.0%] vs
909 [9.4%]), corresponding to 4 (SD 4) fewer deaths per 1000 patients. At 6
months there was a non-significant trend towards a smaller percentage of the
aspirin group being dead or dependent (62.2% vs 63.5%, 2p = 0.07), a difference
of 13 (SD 7) per 1000; after adjustment for baseline prognosis the benefit from
aspirin was significant (14 [SD 6] per 1000, 2p = 0.03). Aspirin-allocated
patients had significantly fewer recurrent ischaemic strokes within 14 days
(2.8% vs 3.9%) with no significant excess of haemorrhagic strokes (0.9% vs
0.8%), so the reduction in death or non-fatal recurrent stroke with aspirin
(11.3% vs 12.4%) was significant. Aspirin was associated with a significant
excess of 5 (SD 1) transfused or fatal extracranial bleeds per 1000; in the
absence of heparin the excess was 2 (SD 1) and was not significant. There was no
interaction between aspirin and heparin in the main outcomes. INTERPRETATION:
Neither heparin regimen offered any clinical advantage at 6 months. The results
suggest that if heparin is given in routine clinical practice, the dose should
not exceed 5000 IU subcutaneously twice daily. For aspirin, the IST suggests a
small but worthwhile improvement at 6 months. Taking the IST together with the
comparably large Chinese Acute Stroke Trial, aspirin produces a small but real
reduction of about 10 deaths or recurrent strokes per 1000 during the first few
weeks. Both trials suggest that aspirin should be started as soon as possible
after the onset of ischaemic stroke; previous trials have already shown that
continuation of low-dose aspirin gives protection in the longer term.
- Language of Publication
- English
- Unique Identifier
- 97317545
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- MeSH Heading (Major)
- Anticoagulants|AD/*TU; Aspirin|AD/*TU; Cerebrovascular Disorders|*DT/MO;
Heparin|AD/*TU; Platelet Aggregation Inhibitors|AD/*TU
- MeSH Heading
- Acute Disease; Aged; Aged, 80 and over; Clinical Protocols; Comparative
Study; Drug Therapy, Combination; Female; Follow-Up Studies; Human; Infusions,
Parenteral; Male; Middle Age; Recurrence; Support, Non-U.S. Gov't; Treatment
Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0140-6736
- Country of Publication
- ENGLAND
Record 7 from database: MEDLINE
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- Title
- Secondary stroke prevention with low-dose aspirin, sustained release
dipyridamole alone and in combination. ESPS Investigators. European Stroke
Prevention Study.
- Author
- Forbes CD
- Address
- University of Dundee Medical School, Scotland, United Kingdom.
- Source
- Thromb Res, 1998 Sep, 92:1 Suppl 1, S1-6
- Abstract
- Patients who had survived a stroke or transient ischaemic attacks (TIA) were
admitted to a trial of low-dose aspirin (50 mg) alone, sustained release
dipyridamole (400 mg/day) alone, or a combination of the two agents, and results
compared with a placebo over 24 months. This low-dose aspirin regimen produced
in pairwise comparisons a significant risk reduction of 18% for stroke, 13% for
stroke and/or death but no reduction in all cause mortality. The sustained
release dipyridamole produced a significant risk reduction of 16% for stroke,
15% for stroke and/or death but no significant reduction of mortality. In
combination, aspirin and dipyridamole produced a risk reduction of 37% in
stroke, 24% in stroke and/or death, and no reduction in mortality. Similar
findings were found in TIA, which was a secondary endpoint. These results are
highly significant in comparison with placebo. As expected, there were enhanced
reports of alimentary side-effects in the aspirin groups and also enhanced
bleeding. Dipyridamole was associated with a slight increase in headache, which
resolved in most patients if therapy was continued. The conclusions are that 50
mg/day of aspirin alone or 400 mg/day of sustained release dipyridamole alone
are equally effective in stroke and TIA prevention. When used in combination the
effects were additive and were significantly more effective than the single
agents.
- Language of Publication
- English
- Unique Identifier
- 98453090
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- MeSH Heading (Major)
- Aspirin|*AD/AE; Cerebrovascular Disorders|DT/*PC; Dipyridamole|*AD/AE;
Fibrinolytic Agents|*AD/AE; Platelet Aggregation Inhibitors|*AD/AE
- MeSH Heading
- Aged; Cerebral Ischemia, Transient|DT; Comparative Study; Delayed-Action
Preparations; Disease-Free Survival; Drug Synergism; Female; Headache|CI;
Hemorrhage|CI; Human; Male; Middle Age; Recurrence
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0049-3848
- Country of Publication
- UNITED STATES
Record 8 from database: MEDLINE
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- Title
- Pregnancy-related death associated with heparin and aspirin treatment for
infertility, 1996.
- Address
-
- Source
- MMWR Morb Mortal Wkly Rep, 1998 May, 47:18, 368-71
- Abstract
- In 1996, a 38-year-old nulliparous woman died from complications of a
cerebral hemorrhage. She was approximately 9 weeks' pregnant with triplets at
the time of her death. The patient had undergone in vitro fertilization (IVF)
and was being treated with anticoagulants (heparin and aspirin) and intravenous
immunoglobulin at the time of her death. This report summarizes the
investigation of this case by state and county health departments with
assistance from CDC.
- Language of Publication
- English
- Unique Identifier
- 98264791
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- MeSH Heading (Major)
- Anticoagulants|*AE; Aspirin|*AE; Cerebral Hemorrhage|*ET/PP; Fertilization
in Vitro|*; Heparin|*AE; Immunoglobulins, Intravenous|*; Platelet Aggregation
Inhibitors|*AE; Pregnancy Complications, Hematologic|*ET/PP
- MeSH Heading
- Adult; Case Report; Fatal Outcome; Female; Human; Immunotherapy|AE;
Pregnancy; Triplets
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0149-2195
- Country of Publication
- UNITED STATES
Record 9 from database: MEDLINE
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- Title
- CAST: randomised placebo-controlled trial of early aspirin use in 20,000
patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial)
Collaborative Group [see comments]
- Address
-
- Source
- Lancet, 1997 Jun, 349:9066, 1641-9
- Abstract
- BACKGROUND: Aspirin is effective in the treatment of acute myocardial
infarction and in the long-term prevention of serious vascular events in
survivors of stroke and myocardial infarction. There is, however, no reliable
evidence on the effectiveness of early aspirin use in acute ischaemic stroke.
METHODS: The Chinese Acute Stroke Trial (CAST) was a large randomised,
placebo-controlled trial of the effects in hospital of aspirin treatment (160
mg/day) started within 48 h of the onset of suspected acute ischaemic stroke and
continued in hospital for up to 4 weeks. The primary endpoints were death from
any cause during the 4-week treatment period and death or dependence at
discharge, and the analyses were by intention to treat. 21,106 patients with
acute ischaemic stroke were enrolled in 413 Chinese hospitals at a mean of 25 h
after the onset of symptoms (10,554 aspirin, 10,552 placebo). 87% had a CT scan
before randomisation. It was prospectively planned that the results would be
analysed in parallel with those of the concurrent. International Stroke Trial
(IST) of 20,000 patients with acute stroke from other countries. FINDINGS: There
was a significant 14% (SD 7) proportional reduction in mortality during the
scheduled treatment period (343 [3.3%] deaths among aspirin-allocated patients
vs 398 [3.9%] deaths among placebo-allocated patients; 2p = 0.04). There were
significantly fewer recurrent ischaemic strokes in the aspirin-allocated than in
the placebo-allocated group (167 [1.6%] vs 215 [2.1%]; 2p = 0.01) but slightly
more haemorrhagic strokes (115 [1.1%] vs 93 [0.9%]; 2p > 0.1). For the
combined in-hospital endpoint of death or non-fatal stroke at 4 weeks, there was
a 12% (6) proportional risk reduction with aspirin (545 [5.3%] vs 614 [5.9%]; 2p
= 0.03), an absolute difference of 6.8 (3.2) fewer cases per 1000. At discharge,
3153 (30.5%) aspirin-allocated patients and 3266 (31.6%) placebo-allocated
patients were dead or dependent, corresponding to 11.4 (6.4) fewer per 1000 in
favour of aspirin (2p = 0.08). INTERPRETATION: There are two major trials of
aspirin in acute ischaemic stroke. Taken together, CAST and the similarly large
IST show reliably that aspirin started early in hospital produces a small but
definite net benefit, with about 9 (SD 3) fewer deaths or non-fatal strokes per
1000 in the first few weeks (2p = 0.001), and with 13 (5) fewer dead or
dependent per 1000 after some weeks or months of follow-up (2p < 0.01).
- Language of Publication
- English
- Unique Identifier
- 97329922
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- MeSH Heading (Major)
- Anti-Inflammatory Agents, Non-Steroidal|AD/AE/*TU; Aspirin|AD/AE/*TU;
Cerebrovascular Disorders|*DT/MO/PP; Platelet Aggregation Inhibitors|AD/AE/*TU
- MeSH Heading
- Acute Disease; Aged; Blood Pressure; China; Female; Follow-Up Studies;
Hospital Mortality; Hospitalization; Human; Male; Middle Age; Placebos;
Recurrence; Support, Non-U.S. Gov't; Tomography, X-Ray Computed; Treatment
Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0140-6736
- Country of Publication
- ENGLAND
Record 10 from database: MEDLINE
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- Title
- Aspirin and heparin prevent hepatic blood stasis and thrombosis induced by
the toxic glycoprotein Bolesatine in mice.
- Author
- Ennamany R; Bingen A; Creppy EE; Kretz O; Gut JP; Dubuisson L; Balabaud C;
Bioulac Sage P; Kirn A
- Address
- UniversitÆe de Bordeaux II, UnitÆe de Formation et de Recherche des Sciences
Pharmaceutiques, France.
- Source
- Hum Exp Toxicol, 1998 Nov, 17:11, 620-4
- Abstract
- Bolesatine is a toxic glycoprotein isolated from Boletus satanas Lenz, which
inhibits protein synthesis in vivo and in vitro. The LD50 (24 h) is 1 mg /kg bw
(i.p.), in mice and rats. When given i.p. to mice (0.1 - 1.0 mg/kg bw)
bolesatine induced thrombi and blood stasis in the liver, 5 - 21 h after
injection, and modifications of the number of blood corpuscles in peripheral
blood. These effects were efficiently reversed by aspirin, ticlopidin and
heparin (as attested by histology and electron microscopy) which however failed
to prevent death in animals given lethal doses. Together, these results showed
that the death of bolesatine poisoned animals given high doses, was rather due
to a combination of thrombosis and other toxic effects. In addition, they
suggest that these antithrombotic drugs may overcome cases of human poisoning,
with low exposures of this boletus, showing a hypertension probably due to
mechanical obstruction which resists normal therapy.
- Language of Publication
- English
- Unique Identifier
- 99081017
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- MeSH Heading (Major)
- Aspirin|*PD; Fungal Proteins|*TO; Hemostasis|*DE; Heparin|*PD; Liver
Diseases|BL/CI/*PC; Protein Synthesis Inhibitors|*TO; Thrombosis|*PC
- MeSH Heading
- Agglutination|DE; Animal; Blood Platelets|DE; Dose-Response Relationship,
Drug; Erythrocytes|DE; Female; Male; Mice; Microscopy, Electron; Support,
Non-U.S. Gov't; Ticlopidine|PD; Time Factors
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0960-3271
- Country of Publication
- ENGLAND
Record 11 from database: MEDLINE
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- Title
- Fixed minidose warfarin and aspirin alone and in combination vs
adjusted-dose warfarin for stroke prevention in atrial fibrillation: Second
Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study [see
comments]
- Author
- Gull‡v AL; Koefoed BG; Petersen P; Pedersen TS; Andersen ED; Godtfredsen J;
Boysen G
- Address
- Copenhagen General Practitioners Laboratory, Denmark. gullov@dadlnet.dk
- Source
- Arch Intern Med, 1998 Jul, 158:14, 1513-21
- Abstract
- BACKGROUND: Despite the efficacy of warfarin sodium therapy for stroke
prevention in atrial fibrillation, many physicians hesitate to prescribe it to
elderly patients because of the risk for bleeding complications and because of
inconvenience for the patients. METHODS: The Second Copenhagen Atrial
Fibrillation, Aspirin, and Anticoagulation Study was a randomized, controlled
trial examining the following therapies: warfarin sodium, 1.25 mg/d; warfarin
sodium, 1.25 mg/d, plus aspirin, 300 mg/d; and aspirin, 300 mg/d. These were
compared with adjusted-dose warfarin therapy (international normalized ratio of
prothrombin time [INR], 2.0-3.0). Stroke or a systemic thromboembolic event was
the primary outcome event. Transient ischemic attack, acute myocardial
infarction, and death were secondary events. Data were handled as survival data,
and risk factors were identified using the Cox proportional hazards model. The
trial was scheduled for 6 years from May 1, 1993, but due to scientific evidence
of inefficiency of low-intensity warfarin plus aspirin therapy from another
study, our trial was prematurely terminated on October 2, 1996. RESULTS: We
included 677 patients (median age, 74 years). The cumulative primary event rate
after 1 year was 5.8% in patients receiving minidose warfarin; 7.2%, warfarin
plus aspirin; 3.6%, aspirin; and 2.8%, adjusted-dose warfarin (P = .67). After 3
years, no difference among the groups was seen. Major bleeding events were rare.
CONCLUSIONS: Although the difference was insignificant, adjusted-dose warfarin
seemed superior to minidose warfarin and to warfarin plus aspirin after 1 year
of treatment. The results do not justify a change in the current recommendation
of adjusted-dose warfarin (INR, 2.0-3.0) for stroke prevention in atrial
fibrillation.
- Language of Publication
- English
- Unique Identifier
- 98343386
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- MeSH Heading (Major)
- Anticoagulants|*AD/AE; Aspirin|*AD/AE; Atrial Fibrillation|CO/*DT;
Cerebrovascular Disorders|ET/*PC; Warfarin|*AD/AE
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Denmark; Drug Administration Schedule; Drug
Therapy, Combination; Female; Hemorrhage|CI; Human; Male; Middle Age; Support,
Non-U.S. Gov't; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0003-9926
- Country of Publication
- UNITED STATES
Record 12 from database: MEDLINE
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- Title
- Prognosis of patients with symptomatic vertebral or basilar artery stenosis.
The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group.
- Address
-
- Source
- Stroke, 1998 Jul, 29:7, 1389-92
- Abstract
- BACKGROUND AND PURPOSE: There are limited data on the prognosis of patients
with angiographically proved symptomatic stenosis of the intracranial vertebral
artery or basilar artery. METHODS: We studied 68 patients with 50% to 99%
stenosis of one of the following arteries: intracranial vertebral (n = 31),
basilar (n = 28), posterior cerebral (PCA) (n = 6), or posterior inferior
cerebellar (PICA) (n = 3). All patients had previous transient ischemic attack
or stroke in the territory of the stenotic artery and were treated with warfarin
(n = 42) or aspirin (n = 26). Follow-up was by chart review and personal or
telephone interview. RESULTS: During a median follow-up of 13.8 months, 15
patients (22%) had an ischemic stroke (4 fatal), 3 patients (4.5%) had a fatal
myocardial infarction (MI) or sudden death, and 6 patients (9%) had a nonfatal
MI. Stroke rates in any vascular territory (per 100 patient-years of follow-up)
were 15.0 in patients with basilar artery stenosis, 13.7 in patients with
vertebral artery stenosis, and 6.0 in patients with PCA or PICA stenosis. Stroke
rates in the same territory as the stenotic artery (per 100 patient-years of
follow-up) were 10.7 in patients with basilar artery stenosis, 7.8 in patients
with vertebral artery stenosis, and 6.0 in patients with PCA or PICA stenosis.
CONCLUSIONS: Patients with symptomatic intracranial vertebral artery or basilar
stenosis are at high risk of stroke, MI, or sudden death. Further studies are
needed to clarify optimal therapy for these patients.
- Language of Publication
- English
- Unique Identifier
- 98321829
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- MeSH Heading (Major)
- Basilar Artery|*; Cerebrovascular Disorders|PC/*PP; Vertebral Artery|*
- MeSH Heading
- Aged; Anticoagulants|TU; Aspirin|TU; Cerebellum|BS; Cerebral Arteries;
Cerebral Ischemia|PC; Constriction, Pathologic; Female; Human; Male; Pilot
Projects; Platelet Aggregation Inhibitors|TU; Prognosis; Retrospective Studies;
Support, Non-U.S. Gov't; Warfarin|TU
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
- ISSN
- 0039-2499
- Country of Publication
- UNITED STATES
Record 13 from database: MEDLINE
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- Title
- ISIS-2: 10 year survival among patients with suspected acute myocardial
infarction in randomised comparison of intravenous streptokinase, oral aspirin,
both, or neither. The ISIS-2 (Second International Study of Infarct Survival)
Collaborative Group.
- Author
- Baigent C; Collins R; Appleby P; Parish S; Sleight P; Peto R
- Address
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield
Department of Clinical Medicine, Radcliffe Infirmary, Oxford OX2 6HE.
ctsu.ox.ac.uk
- Source
- BMJ, 1998 May, 316:7141, 1337-43
- Abstract
- OBJECTIVE: To assess effects of intravenous streptokinase, one month of oral
aspirin, or both, on long term survival after suspected acute myocardial
infarction. DESIGN: Randomised, "2 x 2 factorial," placebo controlled trial.
SETTING: 417 hospitals in 16 countries. SUBJECTS: 17 187 patients with suspected
acute myocardial infarction randomised between March 1985 and December 1987.
Follow up of vital status complete to at least 1 January 1990 for 95% of all
patients and to mid-1997 for the 6213 patients in United Kingdom. INTERVENTIONS:
Intravenous streptokinase (1.5 MU in 1 hour) and oral aspirin (162 mg daily for
1 month) versus matching placebos. MAIN OUTCOME MEASURES: Mortality from all
causes during up to 10 years' follow up, with subgroup analyses based on 4 year
follow up. RESULTS: After randomisation, 1841 deaths were recorded in days 0-35,
991 from day 36 to end of year 1, 1478 in years 2-4, and 1230 in years 5-10.
Allocation to streptokinase was associated with 29 (95% confidence interval 20
to 38) fewer deaths per 1000 patients during days 0-35. This early benefit
persisted (death rate ratio 0.98 (0.92 to 1.04) for additional deaths between
day 36 and end of year 10), so that there were 28 (14 to 42) and 23 (2 to 44)
fewer deaths per 1000 patients treated with streptokinase after 4 years and 10
years respectively. There was no evidence that absolute survival benefit
increased with prolonged follow up among any category of patient, including
those presenting early after symptoms started or with anterior ST elevation. Nor
did the early benefits seem to be lost in any category (including those aged
over 70). Allocation to one month of aspirin was associated with 26 (16 to 35)
fewer deaths per 1000 during first 35 days, with little further benefit or loss
during subsequent years (death rate ratio 0.99 (0.93 to 1.06) between day 36 and
end of year 10). The early benefit obtained with combination of streptokinase
and one month of aspirin also seemed to persist long term. CONCLUSIONS: The
early survival advantages produced by fibrinolytic therapy and one month of
aspirin started in acute myocardial infarction seem to be maintained for at
least 10 years.
- Language of Publication
- English
- Unique Identifier
- 98232444
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- MeSH Heading (Major)
- Aspirin|*AD; Fibrinolytic Agents|*AD; Myocardial Infarction|*DT; Platelet
Aggregation Inhibitors|*AD; Streptokinase|*AD
- MeSH Heading
- Administration, Oral; Adult; Aged; Drug Therapy, Combination; Female;
Follow-Up Studies; Human; Infusions, Intravenous; Male; Middle Age; Support,
Non-U.S. Gov't; Survival Analysis; Survival Rate; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0959-8138
- Country of Publication
- ENGLAND
Record 14 from database: MEDLINE
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- Title
- Effects of prior aspirin and anti-ischemic therapy on outcome of patients
with unstable angina. TIMI 7 Investigators. Thrombin Inhibition in Myocardial
Ischemia.
- Author
- Borzak S; Cannon CP; Kraft PL; Douthat L; Becker RC; Palmeri ST; Henry T;
Hochman JS; Fuchs J; Antman EM; McCabe C; Braunwald E
- Address
- Cardiovascular Division, Henry Ford Hospital, Detroit, Michigan 48202, USA.
- Source
- Am J Cardiol, 1998 Mar, 81:6, 678-81
- Abstract
- Both aspirin and beta-adrenergic blocking drugs have been shown to reduce
the risk of death or acute myocardial infarction (AMI) in patients with unstable
angina, but their effect during chronic use on the presentation of acute
coronary syndromes is less well defined. Calcium antagonists and oral nitrates
are also widely prescribed for patients with coronary disease, but their effect
on presentation of acute myocardial ischemia is unknown. We retrospectively
examined the effects of prior aspirin and anti-ischemic medical therapy on
clinical events in 410 patients hospitalized for unstable angina. Ischemic pain
occurred at rest for a duration of 5 to 60 minutes. During hospitalization, 97%
of patients received aspirin and all received the direct thrombin inhibitor
bivalirudin for at least 72 hours. Despite being older and more likely to have
risk factors for coronary disease and poor outcome, patients receiving aspirin
before admission were less likely to present with non-Q-wave AMI (5% vs 14% in
patients not on aspirin, p = 0.004). Prior beta blocker, calcium antagonist, or
nitrate administration did not appear to modify presentation as unstable angina
or non-Q-wave AMI. In a multivariate model, the combined incidence of death, AMI
not present at enrollment, or recurrent angina was best predicted by age
(adjusted odds ratio [95% confidence interval] 2.38 [1.14 to 3.98]) and presence
of electrocardiographic changes with pain on presentation (adjusted odds ratio
2.83 [1.50 to 5.35]) but was not related to prior or in-hospital medical
therapy. Thus, aspirin but not anti-ischemic therapy before hospitalization of
patients with unstable angina was associated with a decreased incidence of
non-Q-wave AMI on admission.
- Language of Publication
- English
- Unique Identifier
- 98186302
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- MeSH Heading (Major)
- Angina, Unstable|*PC/PP; Aspirin|*TU; Platelet Aggregation Inhibitors|*TU;
Vasodilator Agents|*TU
- MeSH Heading
- Adrenergic beta-Antagonists|TU; Adult; Aged; Calcium Channel Blockers|TU;
Electrocardiography|DE; Female; Human; Male; Middle Age; Nitroglycerin|TU; Odds
Ratio; Retrospective Studies; Support, Non-U.S. Gov't; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0002-9149
- Country of Publication
- UNITED STATES
Record 15 from database: MEDLINE
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- Title
- Thrombosis prevention trial: randomised trial of low-intensity oral
anticoagulation with warfarin and low-dose aspirin in the primary prevention of
ischaemic heart disease in men at increased risk. The Medical Research Council's
General Practice Research Framework [see comments]
- Address
-
- Source
- Lancet, 1998 Jan, 351:9098, 233-41
- Abstract
- BACKGROUND: We aimed to evaluate low intensity oral anticoagulation with
warfarin and low-dose aspirin in the primary prevention of ischaemic heart
disease (IHD). METHODS: 5499 men aged between 45 years and 69 years at high risk
of IHD were recruited from 108 practices in the UK that belong to the Medical
Research Council's General Practice Research Framework. Initially, warfarin or
placebo was randomly allocated to 1427 men; 1013 of these men later moved to a
factorial stage of the trial, retaining their warfarin or placebo warfarin
allocation and adding randomly allocated active or placebo aspirin. Another 4072
men entered directly into the factorial stage making a total of 5085 men. The
four factorial treatment groups were: active warfarin and active aspirin (WA, n
= 1277), active warfarin and placebo aspirin (W, n = 1268), and placebo warfarin
and active aspirin (A, n = 1268), and placebo warfarin and placebo aspirin (P, n
= 1272). The primary end-point was all IHD defined as the sum of coronary death
and fatal and non-fatal myocardial infarction (MI). FINDINGS: The mean
International Normalised Ratio (INR) of those on active warfarin was 1.47. The
mean warfarin dose was 4.1 mg a day (range 0.5 mg-12.5 mg). There were 410 IHD
events (142 fatal, 268 non-fatal). The main effect of warfarin (i.e., WA and W
vs A and P) was a reduction in all IHD of 21% (95% CI 4-35, p = 0.02) chiefly
due to a 39% reduction (15-57, p = 0.003) in fatal events so that warfarin
reduced the death rate from all causes by 17% (1-30, p = 0.04). The main effect
of aspirin (i.e., WA and A vs W and P) was a reduction in all IHD of 20% (1-35,
p = 0.04) almost entirely due to a 32% reduction (12-48, p = 0.004) in non-fatal
events. Absolute reductions in all IHD due to warfarin or aspirin were 2.6 and
2.3 per 1000 person years, respectively. WA reduced all IHD by 34% (11-51, p =
0.006) compared with P. WA increased haemorrhagic and fatal strokes. Ruptured
aortic or dissecting aneurysms occurred in 15 of those who were or had been on
warfarin compared with three of those who had not (p = 0.01). INTERPRETATION:
These results add to evidence that aspirin reduces non-fatal IHD. Warfarin
reduced all IHD chiefly because of an effect on fatal events. Combined treatment
with warfarin and aspirin is more effective in the reduction of IHD than either
agent on its own.
- Language of Publication
- English
- Unique Identifier
- 98118275
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- MeSH Heading (Major)
- Anticoagulants|AD/AE/*TU; Aspirin|AD/AE/*TU; Myocardial Ischemia|MO/*PC;
Platelet Aggregation Inhibitors|AD/AE/*TU; Thrombosis|*PC; Warfarin|AD/AE/*TU
- MeSH Heading
- Administration, Oral; Aged; Cerebrovascular Disorders|CI/EP; Comparative
Study; Double-Blind Method; Drug Therapy, Combination; Factor Analysis,
Statistical; Hemorrhage|CI; Human; Incidence; Male; Middle Age; Primary
Prevention; Risk Factors; Support, Non-U.S. Gov't
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0140-6736
- Country of Publication
- ENGLAND
Record 16 from database: MEDLINE
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- Title
- Randomised double-blind trial of fixed low-dose warfarin with aspirin after
myocardial infarction. Coumadin Aspirin Reinfarction Study (CARS) Investigators
[see comments]
- Address
-
- Source
- Lancet, 1997 Aug, 350:9075, 389-96
- Abstract
- BACKGROUND: Antiplatelet therapy with aspirin and systematic anticoagulation
with warfarin reduce cardiovascular morbidity and mortality after myocardial
infarction when given alone. In the Coumadin Aspirin Reinfarction Study (CARS),
we aimed to find out whether a combination of low-dose warfarin and low-dose
aspirin would give superior results to standard aspirin monotherapy without
excessive bleeding risk. METHODS: We used a randomised double-blind study
design. At 293 sites, we randomly assigned 8803 patients who had had myocardial
infarction, treatment with 160 mg aspirin, 3 mg warfarin with 80 mg aspirin, or
1 mg warfarin with 80 mg aspirin. Patients took a single tablet daily, and
attended for prothrombin time (PT) measurements at weeks 1, 2, 3, 4, 6, and 12,
and then every 3 months. Patients were followed up for a maximum of 33 months
(median 14 months). FINDINGS: The primary event was first occurrence of
reinfarction, non-fatal ischaemic stroke, or cardiovascular death. 1-year
life-table estimates for the primary event were 8.6% (95% CI 7.6-9.6) for 160 mg
aspirin, 8.4% (7.4-9.4) for 3 mg warfarin with 80 mg aspirin, and 8.8% (7.6-10)
for 1 mg warfarin with 80 mg aspirin. Primary comparisons were done with all
follow-up data. The relative risk of the primary event for the 160 mg aspirin
group compared with the 3 mg warfarin with 80 mg aspirin group was 0.95
(0.81-1.12, p = 0.57). For spontaneous major haemorrhage (not procedure
related), 1-year life-table estimates were 0.74% (0.43-1.1) in the 160 mg
aspirin group and 1.4% (0.94-1.8) in the 3 mg warfarin with 80 mg aspirin group
(p = 0.014 log rank on follow-up). For the 3382 patients assigned 3 mg warfarin
with 80 mg aspirin, the INR results were: at week 1 (n = 2985) median 1.51 (IQR
1.23-2.13); at week 4 (n = 2701) 1.27 (1.13-1.64); at month 6 (n = 2145) 1.19
(1.08-1.44). INTERPRETATION: Low, fixed-dose warfarin (1 mg or 3 mg) combined
with low-dose aspirin (80 mg) in patients who have had myocardial infarction
does not provide clinical benefit beyond that achievable with 160 mg aspirin
monotherapy.
- Language of Publication
- English
- Unique Identifier
- 97406189
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- MeSH Heading (Major)
- Aspirin|*AD; Myocardial Infarction|CO/*DT/PC; Warfarin|*AD
- MeSH Heading
- Adult; Aged; Aged, 80 and over; Cardiovascular Diseases|MO; Diabetes
Mellitus|CO; Dose-Response Relationship, Drug; Double-Blind Method; Drug
Combinations; Female; Human; Male; Middle Age; Risk; Support, Non-U.S. Gov't;
Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0140-6736
- Country of Publication
- ENGLAND
Record 17 from database: MEDLINE
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- Title
- Aspirin plus either dipyridamole or ticlopidine is effective in preventing
recurrent myocardial infarction. Secondary Prevention Group.
- Author
- Ishikawa K; Kanamasa K; Hama J; Ogawa I; Takenaka T; Naito T; Yamamoto T;
Nakai S; Oyaizu M; Kimura A; Yamamoto K; Katori R
- Address
- First Department of Internal Medicine, Kinki University, School of Medicine,
Osaka, Japan.
- Source
- Jpn Circ J, 1997 Jan, 61:1, 38-45
- Abstract
- The efficacy of combining antiplatelet agents with low doses of aspirin to
prevent cardiac events in patients with myocardial infarction was examined. A
total of 1,083 patients with prior myocardial infarction were randomly divided
into those who were (618) and were not (465) treated with antiplatelet agents,
and observed for 12.5 +/- 18.5 months. Those treated with antiplatelet agents
included 113 patients treated with aspirin (50 mg) plus dipyridamole (150
mg/day), 253 treated with aspirin (50 mg) plus ticlopidine (200 mg/day), and 252
treated with only 1 of the 3 antiplatelet agents. Cardiac events, including
fatal or nonfatal recurrent myocardial infarction, death by congestive heart
failure, and sudden death, occurred in 34 patients (7.3%) in the nontreatment
group and in 19 patients (3.1%; p < 0.01) in the treatment group; odds ratio
0.40, 95% confidence interval 0.23-0.71. There were only 2 cardiac events (1.8%)
in the aspirin + dipyridamole group (p < 0.05 vs nontreatment group: odds
ratio 0.28: 0.08-1.03), and 5 such events (2.0%) in the aspirin + ticlopidine
group (p < 0.01; odds ratio 0.28: 0.11-0.69). Subgroup analysis to exclude
differences in the patients' background confirmed the efficacy of these
antiplatelet agents. We conclude that combined treatment with low doses of
aspirin plus either dipyridamole or ticlopidine is effective in preventing
cardiac events in patients who have had prior myocardial infarction.
- Language of Publication
- English
- Unique Identifier
- 97224524
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- MeSH Heading (Major)
- Aspirin|*AD; Dipyridamole|*AD; Myocardial Infarction|*PC/PP; Platelet
Aggregation Inhibitors|*AD; Ticlopidine|*AD
- MeSH Heading
- Aged; Drug Therapy, Combination; Female; Follow-Up Studies; Human; Male;
Middle Age; Recurrence
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0047-1828
- Country of Publication
- JAPAN
Record 18 from database: MEDLINE
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- Title
- Use of aspirin, beta-blockers, and lipid-lowering medications before
recurrent acute myocardial infarction: missed opportunities for prevention?
- Author
- McCormick D; Gurwitz JH; Lessard D; Yarzebski J; Gore JM; Goldberg RJ
- Address
- Division of General Medicine/Primary Care/Geriatrics, Meyers Primary Care
Institute, University of Massachusetts Medical Center, Worcester 01655, USA.
- Source
- Arch Intern Med, 1999 Mar, 159:6, 561-7
- Abstract
- BACKGROUND: For patients who have had a previous myocardial infarction (MI),
the use of aspirin, beta-blockers, and lipid-lowering agents reduces the risk of
recurrent MI and death. OBJECTIVE: To examine trends in and determinants of
receipt of these 3 medications before hospitalization for recurrent acute MI
(AMI). METHODS: The study population consisted of 1710 patients with a previous
history of MI hospitalized with a validated recurrent AMI in all hospitals in
Worcester, Mass, during 1986, 1988, 1990, 1991, 1993, and 1995. Logistic
regression analyses were used to assess the effect of demographic, clinical, and
temporal factors on the receipt of aspirin, beta-blockers, and lipid-lowering
medications before hospital admission for recurrent AMI. RESULTS: More than 47%
of patients in each study year were not receiving each medication before
admission, although significant increases in use were noted over time for
aspirin (from 13.5% to 52.6%), beta-blockers (from 33.2% to 44.4%), and
lipid-lowering medications (from 0.8% to 11.7%). In multivariate analyses,
advancing age was associated with not receiving aspirin (odds ratio [OR], 0.67;
95% confidence interval [CI], 0.51-0.89), lipid-lowering medications (OR, 0.14;
95% CI, 0.08-0.25), and beta-blockers (OR, 0.75; 95% CI, 0.57-1.00), although
this effect was of borderline significance for beta-blockers. Being a woman was
associated with not receiving aspirin (OR, 0.78; 95% CI, 0.62-0.98) but was
positively associated with receiving lipid-lowering medications (OR, 1.59; 95%
CI, 1.04-2.43). Coexisting medical conditions and concurrent use of other
cardiovascular medications were also associated with receipt of each medication.
CONCLUSION: Despite encouraging increases over time, the low absolute levels of
receipt of medications shown to be efficacious in the long-term treatment of
patients after an MI, and their variation by age and sex, suggest that
substantial opportunities may exist to prevent recurrent AMIs through the
increased use of aspirin, beta-blockers, and lipid-lowering medications.
- Language of Publication
- English
- Unique Identifier
- 99188498
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- MeSH Heading (Major)
- Adrenergic beta-Antagonists|*TU; Antilipemic Agents|*TU; Aspirin|*TU;
Fibrinolytic Agents|*TU; Myocardial Infarction|*PC
- MeSH Heading
- Aged; Female; Human; Logistic Models; Male; Middle Age; Odds Ratio; Patient
Admission; Recurrence; Support, U.S. Gov't, P.H.S.; Time Factors; Treatment
Outcome
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0003-9926
- Country of Publication
- UNITED STATES
Record 19 from database: MEDLINE
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- Title
- Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel
versus aspirin in patients at risk of ischaemic events.
- Author
- Creager MA
- Address
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115,
USA.
- Source
- Vasc Med, 1998, 3:3, 257-60
- Abstract
- The recent CAPRIE trial (clopidogrel versus aspirin in patients at risk of
ischaemic events) compared clopidogrel with aspirin in reducing the risk of
vascular events in 19,185 patients with clinical manifestations of
atherosclerosis. Participants were randomized to receive daily oral clopidogrel
(75 mg) or aspirin (325 mg). Treatment periods ranged from 1 to 3 years. The
primary outcome measurement was an aggregate of myocardial infarction, ischemic
stroke and vascular death. Event rates of 5.32% and 5.83% were associated with
clopidogrel and aspirin therapy, respectively. Clopidogrel therapy resulted in a
relative risk reduction of 8.7% (CI 0.3-16.5%) compared with aspirin therapy (p
= 0.043). Gastrointestinal hemorrhages occurred in 1.99% of patients treated
with clopidogrel and 2.66% of patients treated with aspirin (p < 0.002).
There were no significant treatment-based differences in the rates of
intracerebral hemorrhages and hemorrhagic deaths or thrombocytopenia. These
results indicate that clopidogrel is more effective and safer than aspirin in
reducing adverse cardiovascular events in patients with atherosclerosis.
- Language of Publication
- English
- Unique Identifier
- 99107538
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- MeSH Heading (Major)
- Aspirin|*TU; Atherosclerosis|*DT; Cerebrovascular Disorders|*/DT/PC;
Myocardial Infarction|*/DT/PC; Platelet Aggregation Inhibitors|*TU;
Ticlopidine|*AA/TU
- MeSH Heading
- Comparative Study; Follow-Up Studies; Human; Risk Assessment; Treatment
Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL; REVIEW; REVIEW, TUTORIAL
- ISSN
- 1358-863X
- Country of Publication
- ENGLAND
Record 20 from database: MEDLINE
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- Title
- Aspirin administration for cardiac-related acute chest pain/angina:
increased use in Medicare patients.
- Author
- Bing M; Abel RL; Pendergrass P; Malone M; Sabharwal K; McCauley C
- Address
- Texas Medical Foundation, Austin 78746-5799, USA.
- Source
- South Med J, 1999 Jan, 92:1, 23-7
- Abstract
- BACKGROUND: Coronary heart disease (CHD), the leading cause of death in the
United States, accounted for approximately 490,000 deaths in 1993. Angina
pectoris, a manifestation of CHD, accounted for 13,586 Medicare discharges in
1993 in Texas. A pilot project showed aspirin prophylaxis that reduces
cardiovascular morbidity and mortality in individuals with acute angina is
underused. Texas Medical Foundation collaborated with 10 acute-care facilities
to improve aspirin prophylaxis. METHODS: Collaborators assessed processes of
care and implemented clinical pathways to improve aspirin administration. Data
were abstracted from medical records before and after pathway implementation to
evaluate impact. RESULTS: Aspirin administration during hospital stay increased
10.8%, aspirin administration on discharge increased 11.7%, and average time
from arrival to aspirin administration decreased 2.9 hours. CONCLUSIONS: Results
suggest collaborator-implemented clinical pathways significantly improved care
received by Medicare patients admitted for cardiac-related acute chest
pain/angina. Data suggest room for further improvement.
- Language of Publication
- English
- Unique Identifier
- 99129602
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- MeSH Heading (Major)
- Angina Pectoris|*DT; Anti-Inflammatory Agents, Non-Steroidal|*TU;
Aspirin|*TU; Physician's Practice Patterns|*
- MeSH Heading
- Acute Disease; Aged; Critical Pathways; Female; Hospitalization; Human;
Male; Medicare; Support, U.S. Gov't, P.H.S.; Texas; United States
- Publication Type
- JOURNAL ARTICLE; MULTICENTER STUDY
- ISSN
- 0038-4348
- Country of Publication
- UNITED STATES
- CAS Registry/EC Number
- 0 (Anti-Inflammatory Agents, Non-Steroidal); 50-78-2 (Aspirin)
Record 21 from database: MEDLINE
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- Title
- Aspirin for primary prevention of cardiovascular events.
- Author
- Augustovski FA; Cantor SB; Thach CT; Spann SJ
- Address
- Hospital Italiano de Buenos Aires, Unidad de Medicina Familiar y Preventiva,
Buenos Aires, Argentina.
- Source
- J Gen Intern Med, 1998 Dec, 13:12, 824-35
- Abstract
- OBJECTIVE: The use of aspirin for primary prevention of cardiovascular
events in the general population is controversial. The purpose of this study was
to create a versatile model to evaluate the effects of aspirin in the primary
prevention of cardiovascular events in patients with different risk profiles.
DESIGN: A Markov decision-analytic model evaluated the expected length and
quality of life for the cohort's next 10 years as measured by quality-adjusted
survival for the options of taking or not taking aspirin. SETTING: Hypothetical
model of patients in a primary care setting. PATIENTS: Several cohorts of
patients with a range of risk profiles typically seen in a primary care setting
were considered. Risk factors considered included gender, age, cholesterol
levels, systolic blood pressure, smoking status, diabetes, and presence of left
ventricular hypertrophy. The cohorts were followed for 10 years. Outcomes were
myocardial infarction, stroke, gastrointestinal bleed, ulcer, and death. MAIN
RESULTS: For the cases considered, the effects of aspirin varied according to
the cohort's risk profile. By taking aspirin, the lowest-risk cohort would be
the most harmed with a loss of 1.8 quality-adjusted life days by taking aspirin;
the highest risk cohort would achieve the most benefit with a gain of 11.3
quality-adjusted life days. Results without quality adjustment favored taking
aspirin in all the cohorts, with a gain of 0.73 to 8.04 days. The decision was
extremely sensitive to variations in the utility of taking aspirin and to
aspirin's effects on cardiovascular mortality. The model was robust to other
probability and utility changes within reasonable parameters. CONCLUSIONS: The
decision of whether to take aspirin as primary prevention for cardiovascular
events depends on patient risk. It is a harmful intervention for patients with
no risk factors, and it is beneficial in moderate and high-risk patients. The
benefits of aspirin in this population are comparable to those of other widely
accepted preventive strategies. It is especially dependent on the patient's risk
profile, patient preferences for the adverse effects of aspirin, and on the
level of beneficial effects of aspirin on cardiovascular-related mortality.
- Language of Publication
- English
- Unique Identifier
- 99061869
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- MeSH Heading (Major)
- Aspirin|*TU; Cardiovascular Diseases|*PC; Decision Support Techniques|*;
Platelet Aggregation Inhibitors|*TU
- MeSH Heading
- Human; Quality of Life; Risk Assessment; Support, Non-U.S. Gov't
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0884-8734
- Country of Publication
- UNITED STATES
- CAS Registry/EC Number
- 0 (Platelet Aggregation Inhibitors); 50-78-2 (Aspirin)
Record 22 from database: MEDLINE
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- Title
- Prevention of myocardial infarction and stroke by aspirin: different
mechanisms? Different dosage?
- Author
- Patrono C
- Address
- Department of Medicine and Aging, University of Chieti, G. D'Annunzio School
of Medicine, Italy. cpatrono@unich.it
- Source
- Thromb Res, 1998 Sep, 92:1 Suppl 1, S7-12
- Abstract
- More than 50 randomized trials have documented the efficacy and safety of
aspirin as an antiplatelet agent and a cardiovascular drug. However, the optimal
dose for preventing coronary and cerebral thrombosis has long been a cause of
debate. For patients with ischaemic heart disease the range recommended for the
prevention of a secondary event, based on strong clinical evidence, is 75-160 mg
aspirin/day. For patients with cerebrovascular disease, recommendations range
from 30-1300 mg/day. If these patients require a higher dose of aspirin it
suggests that a different mechanism of action is involved. This paper considers
hypotheses and reports the findings of recent clinical trials. The SALT study
compared aspirin with placebo in 1360 patients with TIA or minor ischaemic
stroke. It showed an 18% reduction in the risk of stroke or death in patients
receiving 75 mg aspirin/day. Five other trials of 55,000 patients with ischaemic
cerebrovascular disease compared the protective effect of aspirin (range 30-300
mg/day) with placebo, clopidogrel, or oral anticoagulants. Aspirin was better
than placebo, safer than oral anticoagulants, and no different from clopidogrel.
The implications of these findings are discussed. Mechanistic studies and
randomized clinical trials strongly suggest that the mechanism of action and
dose requirement of the antithrombotic effect of aspirin in patients with
cerebrovascular disease is the same as that for ischaemic heart disease.
- Language of Publication
- English
- Unique Identifier
- 98453091
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- MeSH Heading (Major)
- Aspirin|AD/*PD; Cerebrovascular Disorders|DT/*PC; Fibrinolytic
Agents|AD/*PD; Myocardial Infarction|*PC; Platelet Aggregation Inhibitors|AD/*PD
- MeSH Heading
- Human; Myocardial Ischemia|DT; Randomized Controlled Trials
- Publication Type
- JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
- ISSN
- 0049-3848
- Country of Publication
- UNITED STATES
Record 23 from database: MEDLINE
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- Title
- Randomized evaluation of anticoagulation versus antiplatelet therapy after
coronary stent implantation in high-risk patients: the multicenter aspirin and
ticlopidine trial after intracoronary stenting (MATTIS).
- Author
- Urban P; Macaya C; Rupprecht HJ; Kiemeneij F; Emanuelsson H; Fontanelli A;
Pieper M; Wesseling T; Sagnard L
- Address
- Department of Cardiology; La Tour Hospital, GenÄeve, Switzerland.
- Source
- Circulation, 1998 Nov, 98:20, 2126-32
- Abstract
- BACKGROUND: Although the association of ticlopidine and aspirin has been
shown to be superior to anti-vitamin K agents and aspirin after coronary stent
implantation in low-risk patients, the latter combination has remained an
unproven reference regimen for high-risk patients until recently. METHODS AND
RESULTS: We randomized 350 high-risk patients within 6 hours after stent
implantation to receive during 30 days either aspirin 250 mg and ticlopidine 500
mg/d (A+T group) or aspirin 250 mg/d and oral anticoagulation (A+OAC group)
targeted at an international normalized ratio of 2.5 to 3. The primary composite
end point was defined as the occurrence of cardiovascular death, myocardial
infarction, or repeated revascularization at 30 days. Patients were eligible if
(1) the stent(s) were implanted to treat abrupt closure after PTCA; (2) the
angiographic result after implantation was suboptimal; (3) a long segment was
stented (>45 mm and/or >/=3 stents); or (4) the largest balloon inflated
in the stent had a nominal diameter of
- Language of Publication
- English
- Unique Identifier
- 99034566
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- MeSH Heading (Major)
- Anticoagulants|*TU; Aspirin|AE/*TU; Coronary Thrombosis|*PC; Platelet
Aggregation Inhibitors|*TU; Stents|*AE; Ticlopidine|AE/*TU
- MeSH Heading
- Adult; Aged; Comparative Study; Female; Human; Male; Middle Age; Patient
Compliance; Support, Non-U.S. Gov't
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 24 from database: MEDLINE
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- Title
- Randomized multicenter comparison of conventional anticoagulation versus
antiplatelet therapy in unplanned and elective coronary stenting. The full
anticoagulation versus aspirin and ticlopidine (fantastic) study.
- Author
- Bertrand ME; Legrand V; Boland J; Fleck E; Bonnier J; Emmanuelson H; Vrolix
M; Missault L; Chierchia S; Casaccia M; Niccoli L; Oto A; White C; Webb Peploe
M; Van Belle E; McFadden EP
- Address
- Dept de Cardiologie B, HÈopital Cardiologique, 59037 Lille, France.
bertrandme@aol.com
- Source
- Circulation, 1998 Oct, 98:16, 1597-603
- Abstract
- BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be
as effective as or more effective than conventional anticoagulation in patients
with an optimal result after implantation of intracoronary metallic stents.
However, the safety and efficacy of antiplatelet therapy alone in an unselected
population has not been evaluated. METHODS: Patients were randomized to
conventional anticoagulation or to treatment with antiplatelet therapy alone.
Indications for stenting were classified as elective (decided before the
procedure) or unplanned (to salvage failed angioplasty or to optimize the
results of balloon angioplasty). After stenting, patients received aspirin and
either ticlopidine or conventional anticoagulation (heparin or oral
anticoagulant). The primary end point was the occurrence of bleeding or
peripheral vascular complications; secondary end points were cardiac events
(death, infarction, or stent occlusion) and duration of hospitalization.
RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249
to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned
in 42%. Stent implantation was successfully achieved in 99% of patients. A
primary end point occurred in 33 patients (13.5%) in the antiplatelet group and
48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to
0.98], P=0.03). Major cardiac-related events in electively stented patients were
less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet
group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%).
Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6
versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after
coronary stenting significantly reduced rates of bleeding and subacute stent
occlusion compared with conventional anticoagulation.
- Language of Publication
- English
- Unique Identifier
- 98451624
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- MeSH Heading (Major)
- Anticoagulants|AE/*TU; Coronary Disease|CO/*TH; Platelet Aggregation
Inhibitors|AE/*TU; Stents|*; Surgical Procedures, Elective|*
- MeSH Heading
- Administration, Oral; Aged; Arterial Occlusive Diseases|PC; Aspirin|AE/TU;
Comparative Study; Drug Therapy, Combination; Female; Follow-Up Studies;
Hemorrhage|PC; Heparin|TU; Human; Male; Middle Age; Support, Non-U.S. Gov't;
Ticlopidine|AE/TU; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 25 from database: MEDLINE
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- Title
- Randomized multicenter comparison of conventional anticoagulation versus
antiplatelet therapy in unplanned and elective coronary stenting. The full
anticoagulation versus aspirin and ticlopidine (fantastic) study.
- Author
- Bertrand ME; Legrand V; Boland J; Fleck E; Bonnier J; Emmanuelson H; Vrolix
M; Missault L; Chierchia S; Casaccia M; Niccoli L; Oto A; White C; Webb Peploe
M; Van Belle E; McFadden EP
- Address
- Dept de Cardiologie B, HÈopital Cardiologique, 59037 Lille, France.
bertrandme@aol.com
- Source
- Circulation, 1998 Oct, 98:16, 1597-603
- Abstract
- BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be
as effective as or more effective than conventional anticoagulation in patients
with an optimal result after implantation of intracoronary metallic stents.
However, the safety and efficacy of antiplatelet therapy alone in an unselected
population has not been evaluated. METHODS: Patients were randomized to
conventional anticoagulation or to treatment with antiplatelet therapy alone.
Indications for stenting were classified as elective (decided before the
procedure) or unplanned (to salvage failed angioplasty or to optimize the
results of balloon angioplasty). After stenting, patients received aspirin and
either ticlopidine or conventional anticoagulation (heparin or oral
anticoagulant). The primary end point was the occurrence of bleeding or
peripheral vascular complications; secondary end points were cardiac events
(death, infarction, or stent occlusion) and duration of hospitalization.
RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249
to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned
in 42%. Stent implantation was successfully achieved in 99% of patients. A
primary end point occurred in 33 patients (13.5%) in the antiplatelet group and
48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to
0.98], P=0.03). Major cardiac-related events in electively stented patients were
less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet
group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%).
Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6
versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after
coronary stenting significantly reduced rates of bleeding and subacute stent
occlusion compared with conventional anticoagulation.
- Language of Publication
- English
- Unique Identifier
- 98451624
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- MeSH Heading (Major)
- Anticoagulants|AE/*TU; Coronary Disease|CO/*TH; Platelet Aggregation
Inhibitors|AE/*TU; Stents|*; Surgical Procedures, Elective|*
- MeSH Heading
- Administration, Oral; Aged; Arterial Occlusive Diseases|PC; Aspirin|AE/TU;
Comparative Study; Drug Therapy, Combination; Female; Follow-Up Studies;
Hemorrhage|PC; Heparin|TU; Human; Male; Middle Age; Support, Non-U.S. Gov't;
Ticlopidine|AE/TU; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
Record 26 from database: MEDLINE
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- Title
- Aspirin toxicity for human colonic tumor cells results from necrosis and is
accompanied by cell cycle arrest.
- Author
- Subbegowda R; Frommel TO
- Address
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
60153, USA.
- Source
- Cancer Res, 1998 Jul, 58:13, 2772-6
- Abstract
- Chemoprevention of colorectal cancer using aspirin has been demonstrated in
rodents and has been suggested by data from epidemiological studies. The
mechanism that accounts for this prevention is unknown, but it is thought to
relate to an irreversible inhibition of cyclooxygenase and, subsequently,
prostaglandin production. The effect of aspirin on the growth of human colonic
tumor cells was determined in an effort to gain insight into a possible
mechanism of action. In the two cell lines studied, SW 620 and HT-29, we
observed a significant dose- and time-dependent increase in aspirin toxicity in
a concentration range of 1.25-10 mM. This result was independent of
prostaglandin production, because there was no measurable prostaglandin E2 in
cell culture medium. As compared with controls, cells in cultures that contained
aspirin were not detached, which suggests that the mechanism of cell death was
not apoptosis. Flow cytometric analysis revealed an increase in S phase and G2-M
populations as well as the number of subdiploid nuclei in cultures treated with
high-dose aspirin. Confirmation that cells were undergoing necrosis in response
to aspirin was evident from the presence of cells that bound annexin V and
accumulated propidium iodide in the absence of a population that bound annexin
alone. The results suggest that aspirin induces cell cycle arrest and causes
necrosis at high concentrations in vitro, but does not induce apoptosis.
Collectively, these two events, necrosis and cell cycle arrest, may contribute
to the chemopreventive effect that seems to result from long-term administration
of aspirin in vivo.
- Language of Publication
- English
- Unique Identifier
- 98324267
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- MeSH Heading (Major)
- Aspirin|AD/*PD; Colonic Neoplasms|ME/*PA/*PC; Cyclooxygenase
Inhibitors|AD/*PD
- MeSH Heading
- Antineoplastic Agents, Phytogenic|PD; Apoptosis; Cell Cycle|DE; Cell
Division|DE; Dinoprostone|AN; DNA, Neoplasm|DE; Flow Cytometry; Human; HT29
Cells|DE; Necrosis; Neoplasm Proteins|AN; Support, Non-U.S. Gov't;
Vinblastine|PD
- Publication Type
- JOURNAL ARTICLE
- ISSN
- 0008-5472
- Country of Publication
- UNITED STATES
Record 27 from database: MEDLINE
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- Title
- Low-dose aspirin to prevent preeclampsia in women at high risk. National
Institute of Child Health and Human Development Network of Maternal-Fetal
Medicine Units [see comments]
- Author
- Caritis S; Sibai B; Hauth J; Lindheimer MD; Klebanoff M; Thom E; VanDorsten
P; Landon M; Paul R; Miodovnik M; Meis P; Thurnau G
- Address
- Department of Obstetrics and Gynecology, University of Pittsburgh, PA 15213,
USA.
- Source
- N Engl J Med, 1998 Mar, 338:11, 701-5
- Abstract
- BACKGROUND: Whether low-dose aspirin prevents preeclampsia is unclear. It is
not recommended as prophylaxis in women at low risk for preeclampsia but may
reduce the incidence of the disease in women at high risk. METHODS: We conducted
a double-blind, randomized, placebo-controlled trial in four groups of pregnant
women at high risk for preeclampsia, including 471 women with pregestational
insulin-treated diabetes mellitus, 774 women with chronic hypertension, 688
women with multifetal gestations, and 606 women who had had preeclampsia during
a previous pregnancy. The women were enrolled between gestational weeks 13 and
26 and received either 60 mg of aspirin or placebo daily. RESULTS: Outcome data
were obtained on all but 36 of the 2539 women who entered the study. The
incidence of preeclampsia was similar in the 1254 women in the aspirin group and
the 1249 women in the placebo group (aspirin, 18 percent; placebo, 20 percent;
P=0.23). The incidences in the aspirin and placebo groups for each of the four
high-risk categories were also similar: for women with pregestational diabetes
mellitus, the incidence was 18 percent in the aspirin group and 22 percent in
the placebo group (P=0.38); for women with chronic hypertension, 26 percent and
25 percent (P= 0.66); for those with multifetal gestations, 12 percent and 16
percent (P=0.10); and for those with preeclampsia during a previous pregnancy,
17 percent and 19 percent (P=0.47). In addition, the incidences of perinatal
death, preterm birth, and infants small for gestational age were similar in the
aspirin and placebo groups. CONCLUSIONS: In our study, low-dose aspirin did not
reduce the incidence of preeclampsia significantly or improve perinatal outcomes
in pregnant women at high risk for preeclampsia.
- Language of Publication
- English
- Unique Identifier
- 98145769
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- MeSH Heading (Major)
- Aspirin|*AD; Pre-Eclampsia|EP/*PC
- MeSH Heading
- Adult; Chronic Disease; Diabetes Mellitus, Insulin-Dependent|CO;
Double-Blind Method; Female; Human; Hypertension|CO; Incidence; Pregnancy;
Pregnancy in Diabetes|CO; Pregnancy Complications, Cardiovascular; Pregnancy
Outcome; Pregnancy Trimester, Second; Pregnancy, Multiple; Risk Factors;
Support, U.S. Gov't, P.H.S.
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0028-4793
- Country of Publication
- UNITED STATES
Record 28 from database: MEDLINE
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- Title
- A randomized trial of anticoagulants versus aspirin after cerebral ischemia
of presumed arterial origin. The Stroke Prevention in Reversible Ischemia Trial
(SPIRIT) Study Group.
- Address
-
- Source
- Ann Neurol, 1997 Dec, 42:6, 857-65
- Abstract
- Aspirin is only modestly effective in the secondary prevention after
cerebral ischemia. Studies in other vascular disorders suggest that
anticoagulant drugs in patients with cerebral ischemia of presumed arterial
(noncardiac) origin might be more effective. The aim of the Stroke Prevention in
Reversible Ischemia Trial (SPIRIT) therefore was to compare the efficacy and
safety of 30 mg aspirin daily and oral anticoagulation (international normalized
ratio [INR] 3.0-4.5). Patients referred to a neurologist in one of 58
collaborating centers because of a transient ischemic attack or minor ischemic
stroke (Rankin grade < or =3) were eligible. Randomization was concealed,
treatment assignment was open, and assessment of outcome events was masked. The
primary measure of outcome was the composite event "death from all vascular
causes, nonfatal stroke, nonfatal myocardial infarction, or nonfatal major
bleeding complication." The trial was stopped at the first interim analysis. A
total of 1,316 patients participated; their mean follow-up was 14 months. There
was an excess of the primary outcome event in the anticoagulated group (81 of
651) versus 36 of 665 in the aspirin group (hazard ratio, 2.3; 95% confidence
interval [CI], 1.6-3.5). This excess could be attributed to 53 major bleeding
complications (27 intracranial; 17 fatal) during anticoagulant therapy versus 6
on aspirin (3 intracranial; 1 fatal). The bleeding incidence increased by a
factor of 1.43 (95% CI, 0.96-2.13) for each 0.5 unit increase of the achieved
INR. Anticoagulant therapy with an INR range of 3.0 to 4.5 in patients after
cerebral ischemia of presumed arterial origin is not safe. The efficacy of a
lower intensity anticoagulation regimen remains to be determined.
- Language of Publication
- English
- Unique Identifier
- 98065735
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- MeSH Heading (Major)
- Anticoagulants|AE/*TU; Aspirin|AE/*TU; Cerebral Ischemia|*DT/*PC; Platelet
Aggregation Inhibitors|AE/*TU
- MeSH Heading
- Aged; Female; Hemorrhage|CI; Human; Male; Middle Age; Support, Non-U.S.
Gov't; Treatment Outcome
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0364-5134
- Country of Publication
- UNITED STATES
Record 29 from database: MEDLINE
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- Title
- A randomized trial of aspirin versus cilostazol therapy after successful
coronary stent implantation.
- Author
- Kunishima T; Musha H; Eto F; Iwasaki T; Nagashima J; Masui Y; So T; Nakamura
T; Oohama N; Murayama M
- Address
- Department of Cardiology, Yokohama City Seibu Hospital, St. Marianna
University School of Medicine, Japan.
- Source
- Clin Ther, 1997 Sep, 19:5, 1058-66
- Abstract
- Percutaneous transluminal coronary angioplasty (PTCA) is widely used to
treat patients with ischemic heart disease, but the procedure involves a number
of problems, including acute coronary occlusion and restenosis. Although stents
have proved useful for preventing post-PTCA restenosis, especially elastic
recoil during the acute phase, no method has yet been established to prevent
restenosis caused by vascular smooth muscle cell proliferation in the late
phase. Cilostazol selectively inhibits the 3'5'-cyclic-nucleotide
phosphodiesterase (PDE) III (cyclic guanosine monophosphate-inhibited PDE) of
the cyclic adenosine monophosphate PDE family; it also has antithrombotic and
vasodilating effects, as well as an inhibitory effect on vascular smooth muscle
cell proliferation through PDE III inhibition. From November 1995 to March 1997,
the usefulness of cilostazol versus aspirin in preventing subacute thrombosis
and restenosis was studied in 70 patients (55 men and 15 women; 82 total
lesions) who had undergone successful elective Palmaz-Schatz stent implantation.
Patients were randomly allocated to receive aspirin 81 mg/d (40 patients with 45
lesions) or cilostazol 200 mg/d (30 patients with 37 lesions) alone. There was
no difference in patients or angiographic characteristics between these groups.
No subacute thrombosis, acute complications (ie, death, emergent coronary artery
bypass grafting, or hemorrhagic complications), or drug side effects were found
in the cilostazol group. The minimal lumen diameter (mean +/- SD) at follow-up
was 1.89 +/- 1.08 mm in the aspirin group (41 lesions, 5.63 +/- 1.74 months
after stent implantation) and 2.34 +/- 0.74 mm in the cilostazol group (35
lesions, 5.14 +/- 1.91 months after stent implantation), revealing statistically
significant dilatation in the cilostazol group. The restenosis rate was 26.8% in
the aspirin group, compared with 8.6% in the cilostazol group; this difference
was statistically significant. Administration of cilostazol alone after the
implantation of intracoronary Palmaz-Schatz stents was useful for the prevention
of subacute thrombosis and restenosis.
- Language of Publication
- English
- Unique Identifier
- 98046603
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- MeSH Heading (Major)
- Angioplasty, Transluminal, Percutaneous Coronary|*MT; Aspirin|*TU; Coronary
Disease|*PC; Platelet Aggregation Inhibitors|*TU; Tetrazoles|*TU; Thrombosis|*PC
- MeSH Heading
- Comparative Study; Female; Human; Male; Middle Age; Recurrence|PC; Stents
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
- ISSN
- 0149-2918
- Country of Publication
- UNITED STATES
Record 30 from database: MEDLINE
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- Title
- Randomized, double-blind comparison of hirulog versus heparin in patients
receiving streptokinase and aspirin for acute myocardial infarction (HERO).
Hirulog Early Reperfusion/Occlusion (HERO) Trial Investigators [see comments]
- Author
- White HD; Aylward PE; Frey MJ; Adgey AA; Nair R; Hillis WS; Shalev Y; Brown
MA; French JK; Collins R; Maraganore J; Adelman B
- Address
- Green Lane Hospital, Auckland, New Zealand. white002@msn.com
- Source
- Circulation, 1997 Oct, 96:7, 2155-61
- Abstract
- BACKGROUND: Thrombolytic therapy improves survival after myocardial
infarction through reperfusion of the infarct-related artery. Thrombin generated
during thrombolytic administration may reduce the efficacy of thrombolysis. A
direct thrombin inhibitor may improve early patency rates. METHODS AND RESULTS:
Four hundred twelve patients presenting within 12 hours with ST-segment
elevation were given aspirin and streptokinase and randomized in a double-blind
manner to receive up to 60 hours of either heparin (5000 U bolus followed by
1000 to 1200 U/h), low-dose hirulog (0.125 mg/kg bolus followed by 0.25 mg x
kg(-1) x h(-1) for 12 hours then 0.125 mg x kg(-1) x h(-1)), or high-dose
hirulog (0.25 mg/kg bolus followed by 0.5 mg x kg(-1) x h(-1) for 12 hours then
0.25 mg x kg(-1) x h(-1)). The primary outcome was Thrombolysis In Myocardial
Infarction trial (TIMI) grade 3 flow of the infarct-related artery at 90 to 120
minutes. TIMI 3 flow was 35% (95% CI, 28% to 44%) with heparin, 46% (95% CI, 38%
to 55%) with low-dose hirulog, and 48% (95% CI, 40% to 57%) with high-dose
hirulog (heparin versus hirulog, P=.023; heparin versus high-dose hirulog,
P=.03). At 48 hours, reocclusion had occurred in 7% of heparin, 5% of low-dose
hirulog, and 1% of high-dose hirulog patients (P=NS). By 35 days, death,
cardiogenic shock, or reinfarction had occurred in 25 heparin (17.9%), 19
low-dose hirulog (14%), and 17 high-dose hirulog patients (12.5%) (P=NS). Two
strokes occurred with heparin, none with low-dose hirulog, and two with
high-dose hirulog. Major bleeding (40% from the groin site) occurred in 28% of
heparin, 14% of low-dose hirulog, and 19% of high-dose hirulog patients (heparin
versus low-dose hirulog, P<.01). CONCLUSIONS: Hirulog was more effective than
heparin in producing early patency in patients treated with aspirin and
streptokinase without increasing the risk of major bleeding. Direct thrombin
inhibition may improve clinical outcome.
- Language of Publication
- English
- Unique Identifier
- 97477121
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- MeSH Heading (Major)
- Antithrombins|AE/*TU; Aspirin|*TU; Heparin|AE/*TU; Hirudin|*AA/AE/TU;
Myocardial Infarction|*DT; Peptide Fragments|AE/*TU; Streptokinase|*TU;
Thrombolytic Therapy|*
- MeSH Heading
- Analysis of Variance; Comparative Study; Double-Blind Method; Drug
Administration Schedule; Drug Therapy, Combination; Female; Heart
Catheterization; Human; Male; Middle Age; Recombinant Proteins|AE/TU;
Recurrence; Support, Non-U.S. Gov't
- Publication Type
- CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED
TRIAL
- ISSN
- 0009-7322
- Country of Publication
- UNITED STATES
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The Wednesday Letter is a free electronic monthly newsletter written and published by Karl Loren.
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His personal philosophical articles are at PHILOSOPHY.
Copyright © May 20, 2008 6:26 AM by Karl Loren on behalf of Vibrant Life, ALL RIGHTS RESERVED.
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