P342. Meta-analysis: Does aspirin or non-aspirin non-steroidal anti-inflammatory drug use reduce colorectal cancer risk in patients with inflammatory bowel disease?
Nicholas BurrMark A. HullV SubramanianStefania Chetcuti ZammitMaryanne CaruanaKonstantinos H. KatsanosGerassimos J. MantzarisMonica CesariniUri KopylovLouise ZammitPierre Ellul
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Conclusions: Endoscopy at M12 can help to identify long-term responders to thiopurines monotherapy in active CD.A PR could represent the minimal clinically important improvement in endoscopic disease activity.To the Editor.—
In his article (229:1221, 1974), "Aspirin—A Dangerous Drug?," Weiss correctly indicated that aspirin has "become the most widely used drug in the world." In 1972, the American public alone consumed more than 20 million pounds of it. Although aspirin is generally regarded as one of the safest drugs, it is nevertheless responsible for inducing occult gastrointestinal bleeding and may also cause acute and massive gastric hemorrhaging. Weiss further points out that "gastroscopic examination has disclosed the presence of hemorrhagic erosions immediately adjacent to undissolved aspirin tablets." Leonards and Levy1have also noted that "there is now considerable evidence that aspirin-induced gastric or gastrointestinal occult bleeding is usually a local effect resulting from contact of aspirin particles, or of the saturated solution of aspirin surrounding these particles, with the mucosa." Although forms of soluble aspirin, coated aspirin, buffered aspirin, aspirin substitutes, and combinations of aspirin with otherOccult
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It has been reported that non-steroidal anti-inflammatory drugs (NSAIDs) interact with aspirin to influence its antiplatelet effect. For example, there have been reported that the rate of platelet aggregation inhibition associated with aspirin was significantly decreased when ibuprofen was taken before administration of aspirin, as compared with aspirin alone. In this study, we investigated the prescriptions on combination of aspirin with NSAIDs. The subjects were consisted of 1212 patients who were prescribed aspirin in March, 2008 in Tokai University Hachioji Hospital. The patients prescribed combination of aspirin with NSAIDs were 8.1% and 18.6% of those were prescribed in the order of adminstration to induce drug interaction. The pharmacists should provide information about drug interactions of aspirin with NSAIDs to the doctors and patients, and it is necessary to pay attention of these interactions.
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Aims: Acetylsalicylic acid (Aspirin®) is routinely used after CABG as antiplatelet agent. Since the pyrazole analgesic dipyrone (Novalgin®) is often co-administered with aspirin and also known to interact with cyclooxygenase, the target of aspirin, we hypothesized that a drug interaction between aspirin and novalgin may contribute to aspirin resistance.
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Hepatocellular carcinoma (HCC) is the seventh most prevalent cancer globally and is the third leading cause of cancer-related mortality.The aim of this study was to evaluate the effect of aspirin use on the survival rates of individuals diagnosed with HCC.The patients were divided into two groups: those who used aspirin and those who did not. Aspirin use was defined as individuals who had used aspirin either before or after the diagnosis of HCC. Aspirin usage was determined based on prescription records. The criteria for aspirin use were defined as a minimum of 3 months and a minimum daily dose of 100 mg. Survival time; The time elapsed after the diagnosis of HCC was calculated as 'months'.Of the 300 cohorts studied in our study, 104 (34.6%) were using aspirin, while 196 (65.4%) were not. It was observed that bleeding occurred only in the patient group taking aspirin ( P = 0.002). When evaluated in terms of survival time, it was observed that it was significantly higher in the patient group using aspirin ( P = 0.001). Aspirin use was identified as factors that significantly impact survival ( P < 0.05). Aspirin use was identified as independent risk factors that significantly impact of survival ( P < 0.05).The aspirin group had a similar metabolic and liver reserve as the other group and had a longer survival despite being older and more comorbid diseases.
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Background and Purpose— Aspirin is used commonly to prevent ischemic strokes and other vascular events. Although aspirin is considered safe and effective, it has limited efficacy with a relative risk reduction of 20% to 25% for ischemic stroke. We sought to determine if aspirin as currently used is having its desired antiplatelet effects. Methods— We ascertained patients with cerebrovascular disease who were taking only aspirin as an antiplatelet agent. Platelet function was evaluated using a platelet function analyzer (PFA-100). PFA test results were correlated with aspirin dose, formulation, and basic demographic factors. Results— We ascertained 129 patients, of whom 32% were taking an enteric-coated aspirin preparation and 32% were taking low-dose (≤162 mg/d) aspirin. For the entire cohort, 37% of patients had normal PFA-100 results, indicating normal platelet function. For the patients taking low-dose aspirin, 56% had normal PFAs compared with 28% of those taking ≥325 mg/d of aspirin, while 65% of patients taking enteric-coated aspirin had normal PFAs compared with 25% taking an uncoated preparation ( P <0.01 for both comparisons). Similar results were obtained if PFA results were analyzed using mean closure times (low-dose aspirin, 183 sec; high-dose aspirin, 233 sec; enteric-coated, 173 sec; uncoated, 235 sec; P <0.01 for comparisons). Older patients and women were less likely to have a therapeutic response to aspirin, independent of aspirin dose or formulation. Conclusions— A significant proportion of patients taking low-dose aspirin or enteric-coated aspirin have normal platelet function as measured by the PFA-100 test. If these results correlate with clinical events, they have broad implications in determining how aspirin is used and monitored.
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To evaluate the effectiveness of the AggreGuide A-100, a point-of-care platelet aggregometer, in detecting aspirin-induced platelet dysfunction at high and low doses of aspirin. Sixty-five individuals who had not been taking aspirin in the previous 14 days were recruited for the High-Dose Aspirin Study and were administered a single high dose of aspirin (650 mg). Thirteen subjects who had been aspirin-free for 7 to 10 days were subsequently recruited for the Low-Dose Aspirin Study and were administered a low dose of aspirin (81mg/day) for 7 to 10 days. We obtained measurements of the subjects’ whole-blood samples using the AggreGuideA-100 at baseline and after the ingestion of aspirin in both groups. In the High-Dose Aspirin Study, 59 of the 65 subjects (91%) exhibited a reduction in their platelet aggregation index (PAI) value, as measured by the AggreGuide A-100, after taking a single 650 mg dose of aspirin. In the Low-Dose Aspirin Study, all 13 subjects (100%) exhibited a reduction in their PAI value, as measured by the AggreGuide A-100, after taking 81 mg per day of aspirin for 7 to 10 days. The results from the High- and Low-Dose Aspirin Groups indicate that the AggreGuide A-100 yields prompt, reliable measurement of aspirin-induced dysfunction, as indicated by a decreasing PAI value, in the presence of high or low doses of aspirin.
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Background: Aspirin resistance has been defined as inability of aspirin to protect individuals from thrombotic complications or to produce an anticipated effect from laboratory tests of platelet function. Most reported information comes from Western patients with coronary artery disease and aspirin resistance is defined by laboratory criteria. The purpose of the present study was to look for aspirin non-responders in Thai patients who presented with acute/subacute ischemic stroke and transient ischemic attack (TIA). Material and Method: The authors prospectively included acute ischemic stroke/ TIA patients who were treated at Thammasat Hospital from August, 2006 to July, 2007 and had already been on aspirin. Information about compliance of medication, reasons for taking aspirin, doses of aspirin, baseline characteristics, and stroke subtypes of the patients were collected. Results: There were 194 acute/subacute ischemic stroke/TIA patients during the study period. Forty-six patients (23.7%), who had already been on aspirin (aspirin non-responder), while having new stroke/TIA, were studied. Eighteen patients were on aspirin 300-325 mg and 28 patients were on 81 mg per day. Most patients had taken aspirin 300-325mg/day as secondary prevention, while half of the patients taking aspirin 81 mg/d had diabetes mellitus and took aspirin as primary prevention. Conclusion: Aspirin non-responders in ischemic stroke patients are common. Future study is required to clarify mechanisms of aspirin non-responders in Thai patients. Keywords: Aspirin non-responder, Stroke, Thai
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이영경•김한성•박지영•강희정 한림대학교 의과대학 진단검사의학교실
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Background The present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly taking aspirin. Methods The patients in this group were all stroke survivors who have formerly been diagnosed with a cerebral infarction or transient ischemic attack (TIA) in our hospital. We investigated their use of aspirin over a three-year period following their hospitalization. According to the patients' aspirin usage, they were divided into treatment and non-treatment groups. In addition, the reasons for not taking or irregularly taking aspirin were analyzed in the two groups. Results A total of 1240 patients were studied, including 367 (29.60%) in the treatment group and 873 (70.40%) cases in the non-treatment group. In addition, 201 (16.20%) cases in the treatment group had been regularly taking aspirin (50-325 mg of aspirin daily) for 1 to 3 years or longer. The results demonstrated that the main reasons for not taking aspirin in this study were related to patients' concerns regarding the side effects of taking aspirin (46.45%), as well as the doctors' inadequacy in informing their patients to take aspirin (38.71%). The major reasons for patients to irregularly take aspirin were that the doctors did not notify the length of aspirin usage to their patients (41.57%), and that doctors did not prescribe aspirin upon the patients' follow-up visit (26.51%). Conclusion The most effective way to increase patient's compliance for aspirin consumption is to promote the guidelines for stroke treatment and to relay these advances in stroke therapy to the patient.
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Little is known about the contribution of over-the-counter (OTC) aspirin to cardiovascular prophylaxis. To investigate this, a two-phase cross-sectional study was carried out in nine general practices in North Staffordshire. In the first phase, all patients with cardiovascular disease (CVD) were identified from computer searches using morbidity registers and drug searches. The search also identfied the subgroup receiving prescribed prophylactic aspirin. In the second phase, a questionnaire was posted to all patients with CVD who were not on prescribed aspirin to establish their current use of OTC aspirin. Overall, 69% of the CVD group used aspirin, with 26% of aspirin being OTC. OTC aspirin use was more common in those aged under 65 years, men, and the more affluent. Also, there were significant differences in OTC aspirin use between the various practices. This study shows that a considerable amount of aspirin is used OTC in those with CVD. Its use is influenced by several factors that could be addressed when considering attempts to improve the overall uptake of aspirin.
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