BACKGROUND: Aspirin is the most common drug used for the prevention of arterial thrombosis. However, platelet responsiveness to aspirin is variable among individuals and it is important to detect aspirin resistance to improve clinical outcome. We analyzed the changes of platelet reactivity before and after aspirin treatment. We also investigated the incidence and influencing factors of aspirin resistance in Korean. METHODS: We tested platelet function in 198 patients who had been treated with aspirin in a Korean university hospital, and 59 of these patients were tested for platelet function before and after aspirin treatment. We also analyzed platelet reactivity in 136 patients who had not been treated with aspirin. Platelet function was tested using the VerifyNow Aspirin Assay (Accumetrics, USA). Platelet reactivity was expressed as aspirin reaction unit (ARU) and > or =550 ARU was defined as aspirin resistance. RESULTS: Platelet reactivity of 136 patients who had not been treated with aspirin was 632.2+/-46.3 ARU (mean+/-SD) (range, 462-675). Platelet reactivity of 198 patients who had been treated with aspirin was 472.5+/-60.0 (338-666) ARU, and 10.1% of patients were aspirin-resistant. The difference of platelet reactivity before and after aspirin treatment was 128.3+/-68.7 (-40-248) ARU. Hb level was lower and platelet count was higher in aspirin-resistant group than in aspirin-sensitive group (P<0.05). CONCLUSIONS: We demonstrated the distribution of platelet reactivity before and after aspirin treatment using the VerifyNow Aspirin Assay. The incidence of aspirin resistance was 10.1%, and low Hb level and high platelet count were related with aspirin resistance.
Aged ; Aspirin/pharmacology/*therapeutic use ; Drug Resistance ; Female ; Hospitals, University ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/pharmacology/*therapeutic use ; Platelet Function Tests ; Predictive Value of Tests

Aspirin ; pharmacology ; Drug Resistance ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; methods ; Phytotherapy

OBJECTIVETo investigate the curative effect and safety of buyang huanwu decoction (BHD) combined aspirin (ASP) in treatment of aspirin resistance (AR) patients at transient ischemic attack (TIA).

METHODSRecruited were 86 AR patients at TIA who took ASP as the secondary prevention. Two cases were rejected due to poor compliance. The rest 84 patients were randomly assigned to the treatment group and the control group. Those in the treatment group were treated with BHD and ASP, while those in the control group took Clopidogrel and ASP. After 30-, 60-, and 90-day of treatment, arachidonic acid (AA) and adenosine diphosphate (ADP) induced platelet aggregation rate (PAG) were detected using turbidimetry. After treatment of 90 days, the case numbers of TIA recurrence or of progressing to cerebral infarction were counted. The incidence of adverse events was also observed.

RESULTSThe ADP-and AA-induced PAG showed similar decreasing tendency in the treatment group and the control group at each time point (P >0.05). There was no statistical difference in the risk control of end point events (including ischemic cerebrovascular diseases, TIA recurrence, cerebral infarction) between the two groups (P >0.05). One patient suffered from bleeding (mild gastrointestinal bleeding) in the treatment group, while 4 patients suffered from bleeding (3 due to skin and mucous membrane bleeding and 1 to stool bleeding). The bleeding risk was lowered by 76.29% in the treatment group when compared with the control group.

CONCLUSIONSBHD combined ASP showed similar efficacy in treating AR and controlling endpoint events. Besides, they lowered bleeding risk.

Adult ; Aged ; Aged, 80 and over ; Aspirin ; pharmacology ; therapeutic use ; Drug Resistance ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Ischemic Attack, Transient ; drug therapy ; Male ; Middle Aged ; Treatment Outcome

Nitric oxide (NO) as a messenger and/or effector plays important roles in vivo. The decreased availability of NO or dysfunction in NO signaling has often been implicated in the development and progression of diseases, and design and research of NO-donating drugs has become one of the important strategies in drug discovery. In connection with authors' scientific practice, this article reviews the recent advances in the research of NO-donating drugs.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Antineoplastic Agents ; pharmacology ; therapeutic use ; Aspirin ; analogs & derivatives ; pharmacology ; therapeutic use ; Azo Compounds ; pharmacology ; Cardiovascular Diseases ; drug therapy ; Cell Line, Tumor ; Drug Design ; Humans ; Neoplasms ; drug therapy ; pathology ; Nitrates ; pharmacology ; therapeutic use ; Nitric Oxide ; metabolism ; Nitric Oxide Donors ; pharmacology ; therapeutic use ; Piperazines ; pharmacology ; Signal Transduction ; drug effects

OBJECTIVETo evaluate the impact of different proton pump inhibitors on the antiplatelet activity of clopidogrel.

METHODSA total of 60 hospitalized patients undergoing percutaneous coronary intervention were randomly assigned to receive omeprazole group 40 mg/d (20 patients), pantoprazole group 40 mg/d (20 patients) and control group (20 patients). All patients also received standard clopidogrel therapy, continuing 30 days treatments. The percentage clotting inhibition was measured by the use of thrombelastogram and the maximal platelet aggregation rate (MPAR) was measured by turbidity method at the first day before admission and 15 or 30 days after treatment. Major adverse cardiac and cerebral events (MACCE) and hemorrhagic events within 30 days were recorded.

RESULTSThe baseline clinical characteristics, angiography and PCI result were compared among the three groups. At the first day before admission and 15 or 30 days after treatment, no significant difference was shown in the percentage clotting inhibition measured by thrombelastogram and the maximal platelet aggregation rate (MPAR) measured by turbidity method among the three groups. Though the platelet agglutination inhibition rate measured at 15 and 30 days increased and MPAR measured at 15 and 30 days declined compared with the baseline data (P < 0.05), no significant difference was found between levels measured at 15 and 30 days (P > 0.05). The rates of MACCE had no significant difference among the three groups. Compared with control group, the rates of hemorrhagic event were significantly decreased in omeprazole or pantoprazole group (P < 0.05), but no significant difference was shown between the omeprazole and pantoprazole group.

CONCLUSIONNo significant impact of different proton pump inhibitors on the antiplatelet activity of clopidogrel has been found in patients undergoing coronary stent implantation and short-time combined administration is safe.

2-Pyridinylmethylsulfinylbenzimidazoles ; pharmacology ; therapeutic use ; Adult ; Aged ; Angioplasty, Balloon ; Aspirin ; pharmacology ; therapeutic use ; Coronary Disease ; therapy ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Omeprazole ; pharmacology ; therapeutic use ; Platelet Aggregation ; drug effects ; Postoperative Period ; Proton Pump Inhibitors ; pharmacology ; therapeutic use ; Stents ; Ticlopidine ; analogs & derivatives ; pharmacology ; therapeutic use

Angioplasty, Balloon, Coronary ; adverse effects ; Aspirin ; pharmacology ; therapeutic use ; Coronary Angiography ; Drug-Eluting Stents ; adverse effects ; Humans ; Male ; Middle Aged ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; therapeutic use ; Sirolimus ; pharmacology ; therapeutic use ; Ticlopidine ; analogs & derivatives ; pharmacology ; therapeutic use ; Treatment Outcome ; Tyrosine ; analogs & derivatives ; pharmacology ; therapeutic use

OBJECTIVETo study whether effect of aspirin plus low-dose diethylstilbestrol is more effective and safer than high diethylstilbestrol dose alone on prevention of ovariectomy-induced osteopenia and dyslipidemia.

METHODSThirty-eight 4-month-old female SD rats were divided into baseline (BAS) group (n=6), sham operation group (n=8) and ovariectomy (OVX) group (n=24). The OVX group was further divided into vehicle treatment group (n=8), diethylstilbestrol (30 μg/kg•d) treatment group (OVX+D30 group, n=8), and aspirin (9 mg/kg•d) plus diethylstilbestrol (10 μg/kg•d) treatment group (OVX+A-D10 group, n=8). Their left tibiae were collected for the bone histomorphometric analysis in undecalcified sections. Left femurs were collected for the bone mineral density measurement.

RESULTSThe body weight and serum cholesterol were increased, while uterine weight and cancellous bone mass were decreased in OVX rats compared with the SHAM group. Cancellous bone mass was significantly increased, while body weight and bone resorption parameters were decreased in both A-D10 and D30 treatment group compared with OVX group. The rats treated with A-D10 showed significantly increased in bone formation parameters and decreased in serum triglyceride compared with the D30-treated rats.

CONCLUSIONAspirin plus low-dose diethylstilbestrol can effectively prevent osteopenia by reducing bone resorption, and is thus a better treatment modality for preventing dyslipidemia than high-dose diethylstilbestrol alone.

Animals ; Anti-Inflammatory Agents, Non-Steroidal ; pharmacology ; therapeutic use ; Aspirin ; pharmacology ; therapeutic use ; Biomarkers ; blood ; Body Weight ; drug effects ; Bone Density ; Bone Diseases, Metabolic ; blood ; prevention & control ; Bone and Bones ; drug effects ; Diethylstilbestrol ; pharmacology ; therapeutic use ; Drug Evaluation, Preclinical ; Drug Therapy, Combination ; Dyslipidemias ; blood ; prevention & control ; Estrogens, Non-Steroidal ; pharmacology ; therapeutic use ; Female ; Organ Size ; drug effects ; Ovariectomy ; Rats ; Uterus ; drug effects

OBJECTIVEVigna subterranea is widely consumed as a traditional staple food in Nigeria and some West African countries. The ethanolic seed extract of V. subterranea (EEVS) was investigated for its gastroprotective effects on aspirin plus pylorus ligation-induced gastric ulcerated rats using an in vivo assay.

METHODSGastric mucosal ulceration was induced experimentally in Groups 2 to 5 using aspirin plus pylorus ligation. Rats in Group 1 were orally pretreated with 3% Tween 80 only as normal control. Groups 2 to 5 were pretreated with 3% Tween 80 (ulcer group), 20 mg/kg of omeprazole (positive group), and 200 and 400 mg/kg of EEVS (experimental groups), respectively, once daily for 21 days before ulcer induction. Parameters including those for gastric secretions, ulcerated areas and gastric wall histology were assessed. Levels of superoxide dismutase (SOD), glutathione peroxidase (GP), and malondialdehyde (MDA) in the gastric tissue homogenate were also determined.

RESULTSPretreatment with EEVS significantly (P < 0.05) reduced the ulcer index, gastric volume and total acidity in rats with aspirin plus pylorus ligation-induced ulcer. The pH and mucus of gastric content increased significantly (P < 0.05) while the levels of SOD and GP were observed to be elevated with a reduced amount of MDA. Significant severe gastric mucosal injury was exhibited in the ulcer group and EEVS or omeprazole offered significant (P < 0.05) protection against mucosal ulceration. Histologically, the gastric submucosal layer showed remarkable decrease in edema and leucocytes infiltration compared with ulcer group.

CONCLUSIONThe study suggests that EEVS offered a protective action against aspirin plus pylorus ligation-induced gastric ulcers in Wistar rats. The protective effect might be mediated via antisecretory, cytoprotective and antioxidative mechanisms.

Animals ; Anti-Ulcer Agents ; pharmacology ; therapeutic use ; Antioxidants ; pharmacology ; therapeutic use ; Aspirin ; Edema ; Gastric Mucosa ; drug effects ; metabolism ; pathology ; Gastrointestinal Agents ; pharmacology ; therapeutic use ; Glutathione Peroxidase ; metabolism ; Hydrogen-Ion Concentration ; Leukocytes ; Male ; Malondialdehyde ; metabolism ; Mucus ; metabolism ; Nuts ; Phytotherapy ; Plant Extracts ; pharmacology ; therapeutic use ; Rats, Wistar ; Severity of Illness Index ; Stomach Ulcer ; chemically induced ; drug therapy ; metabolism ; prevention & control ; Superoxide Dismutase ; metabolism ; Vigna

OBJECTIVE: To evaluate correlation between and agreement in light transmittance aggregation (LTA) and thromboelastography (TEG) in laboratory diagnosing aspirin resistance (AR), and to determine the prevalence of AR in old patients. METHODS: Patients in the Wanshoulu District of Beijing with ischemic atherothrombotic diseases were recruited. Inclusion criteria were age ≥ 65 years, and having received regular aspirin therapy (75-100 mg daily) for at least 4 weeks. On the basis of LTA assay, the definition of AR was taken as aggregation of ≥ 20% with AA (arachidonic acid), and of ≥ 70% with ADP (adenosine diphosphate). Aspirin-sensitivity was indicated by the absence of either of these criteria; aspirinsensitivity was indicated as both criteria being met. The definition of AR by TEG is ≥ 50% via AA-induced whole blood aggregation. RESULTS: There were 13.69% prevalence of aspirin resistance for LTA using AA as the agonist, 30.16% prevalence of aspirin resistance for LTA using ADP as the agonist, and 23.67% prevalence of aspirin resistance for TEG using AA as the agonist. Results from these tests showed poor agreement (Kappa<0.4). However, by the method of LTA using AA and ADP as the agonists, prevalence of AR was 8.35%. By methods of AA-induced LTA and AA-induced TEG, prevalence of AR was 8.82%. Results from these two latter methods showed good agreement (Kappa = 0.793). CONCLUSION Combined methods, as described here, have good correlation and agreement in the assays of AR, and the results with them represent a realistic measure of the prevalence of AR. Prevalence of AR of elderly patients from Wanshoulu district of Beijing is about 9%.
Aged ; Aspirin ; pharmacology ; therapeutic use ; Cerebrovascular Disorders ; blood ; drug therapy ; Coronary Disease ; blood ; drug therapy ; Drug Resistance ; Female ; Humans ; Male ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; therapeutic use ; Prevalence ; Surveys and Questionnaires

The NCCN has recently released its 2017 version 1.0 guideline for colorectal cancer. There are several updates from this new version guideline which are believed to change the current clinical practice. Update one, low-dose aspirin is recommended for patients with colorectal cancer after colectomy for secondary chemoprevention. Update two, biological agents are removed from the neoadjuvant treatment regimen for resectable metastatic colorectal cancer (mCRC). This update is based on lack of evidence to support benefits of biological agents including bevacizumab and cetuximab in the neoadjuvant setting. Both technical criteria and prognostic information should be considered for decision-making. Currently biological agents may not be excluded from the neoadjuvant setting for patients with resectable but poor prognostic disease. Update three, panitumumab and cetuximab combination therapy is only recommended for left-sided tumors in the first line therapy. The location of the primary tumor can be both prognostic and predictive in response to EGFR inhibitors in metastatic colorectal cancer. Cetuximab and panitumumab confer little benefit to patients with metastatic colorectal cancer in the primary tumor originated on the right side. On the other hand, EGFR inhibitors provide significant benefit compared with bevacizumab-containing therapy or chemotherapy alone for patients with left primary tumor. Update four, PD-1 immune checkpoint inhibitors including pembrolizumab or nivolumab are recommended as treatment options in patients with metastatic deficient mismatch repair (dMMR) colorectal cancer in second- or third-line therapy. dMMR tumors contain thousands of mutations, which can encode mutant proteins with the potential to be recognized and targeted by the immune system. It has therefore been hypothesized that dMMR tumors may be sensitive to PD-1 inhibitors.
Antibodies, Monoclonal ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspirin ; administration & dosage ; therapeutic use ; Bevacizumab ; therapeutic use ; Biological Products ; therapeutic use ; Brain Neoplasms ; drug therapy ; genetics ; Cetuximab ; therapeutic use ; Clinical Decision-Making ; methods ; Colorectal Neoplasms ; drug therapy ; genetics ; pathology ; prevention & control ; therapy ; Contraindications ; Humans ; Mutation ; physiology ; Neoadjuvant Therapy ; standards ; Neoplasm Metastasis ; drug therapy ; Neoplastic Syndromes, Hereditary ; drug therapy ; genetics ; Practice Guidelines as Topic ; Prognosis ; Secondary Prevention ; methods ; standards