Tufted angioma (TA) is a rare, benign, vascular neoplasm of the skin. The diagnosis of this condition is infrequent due to its rare occurrence. Only 158 cases have been described as of 2015. The treatment reported in the literature is very limited with no clear guidelines on its management. Currently, there are no reported cases in the Philippines of TA treated with aspirin. This is a case of a 1-year-old Filipino boy presenting with multiple dusky red papules and plaques on the left side of the cheek, pre- and postauricular areas, parieto-occipital areas, chest, and upper back. His lesions started at 2 months of age, noted to increase in size, number, and thickness over time. Dermoscopy revealed homogenous erythematous background with perifollicular lacunae separated by thin septa. Histopathology revealed dilated vessels in the papillary dermis with proliferation of endothelial cells in lobules, surrounded by dilated crescent-shaped vascular channels in the dermis. The patient was treated with low-dose aspirin (5 mg/kg/day) once a day for 1 month with improvement. After 4 months from treatment, no new lesions, no increase in size, nor symptoms were noted. Low-dose aspirin is an effective and safe option for monotherapy of TA in pediatric patients.

Essential thrombocytosis (ET) is one of the myeloproliferative neoplasms (MPNs) which increase the probability of thrombosis and bleeding. ET is usually discovered as an incidental finding on blood workup and in rare cases, will present as vascular events such as stroke. Our patient, a 77-year-old female, a case of acute cerebral infarct presented with numbness and severe weakness of left upper and lower extremity. Serial complete blood count showed an elevated platelet count. Bone marrow aspiration studies showed increased number of enlarged megakaryocytes. She was diagnosed as a case of ET and maintained on Aspirin 80 mg per tablet once a day and Hydroxyurea 500 mg per tablet once a day.

OBJECTIVE: To observe the clinical efficacy of heat-sensitive moxibustion combined with western medication for preconception intervention in prethrombotic state of recurrent spontaneous abortion (RSA) with kidney deficiency and blood stasis. METHODS: A total of 100 RSA patients of prethrombotic state with kidney deficiency and blood stasis were randomized into a combination group (50 cases, 5 cases were eliminated) and a medication group (50 cases, 5 cases were eliminated). In the medication group, the aspirin enteric-coated tablet was given orally at a dose of 75 mg a time, once daily. On the basis of the treatment in the medication group, in the combination group, heat-sensitive moxibustion was applied at the heat-sensitive points selected among the areas of Guanyuan (CV4), Shenque (CV8), and bilateral Sanyinjiao (SP6), Zusanli (ST36), Qihai (CV6), Taixi (KI3), Zigong (EX-CA1), Luanchao (Extra), Xuehai (SP10), and Yinlingquan (SP9), about 40 min a time, once every two days. Both groups were treated for 3 menstrual cycles continuously. Pregnancy success rate of 12 weeks was recorded in the two groups in follow-up of 3 months after treatment completion, during which conception was tried under the guidance of doctor. The TCM symptom score was observed and the coagulation-fibrinolysis indexes (activated partial thromboplastin time [APTT], prothrombin time [PT], platelet count [PLT], D-dimer [D-D], fibrinogen [FIB], protein S [PS], protein C [PC] and antithrombin Ⅲ [AT-Ⅲ]) were detected before and after treatment in the two groups. RESULTS: The pregnancy success rate of 12 weeks was 80.0% (32/40) in the combination group, which was higher than 54.3% (19/35) in the medication group (P<0.05). After treatment, the TCM symptom scores were decreased compared with those before treatment in the two groups (P<0.05), and the TCM symptom score in the combination group was lower than that in the medication group (P<0.05). Compared before treatment, the APTT and PT was prolonged (P<0.05), the levels of PLT, FIB and D-D were reduced (P<0.05), the activity of AT-Ⅲ, PS and PC was increased (P<0.05) after treatment in the two groups. After treatment, in the combination group, the APTT was longer (P<0.05), the levels of PLT, FIB and D-D were lower (P<0.05), the activity of AT-Ⅲ, PS and PC was higher (P<0.05) than those in the medication group. CONCLUSION Heat-sensitive moxibustion combined with western medication can effectively improve the prethrombotic state and TCM clinical symptoms in RSA patients with kidney deficiency and blood stasis, enhance pregnancy success rate, its mechanism may be related to ameliorating hypercoagulability.
Humans ; Female ; Moxibustion ; Adult ; Pregnancy ; Abortion, Habitual/blood* ; Young Adult ; Combined Modality Therapy ; Kidney/drug effects* ; Acupuncture Points ; Aspirin/administration & dosage*

OBJECTIVE: To review current status of clinical application and research progress of different anticoagulants in perioperative period of free flap transplantation. METHODS: A comprehensive review of recent relevant literature was conducted, focusing on clinical research concerning the application of anticoagulants in the perioperative period of free flap transplantation. The administration route, timing, dosage selection, effectiveness, and safety of commonly used and novel anticoagulants were summarized. RESULTS: At present, the anticoagulants mainly used in the perioperative period of free flap transplantation include drugs for venous thrombosis prophylaxis, drugs for arterial thrombosis prophylaxis, and physical/colloidal anticoagulants, etc. The administration strategies can be classified into two major categories: single-agent anticoagulation and combined anticoagulation. Single-agent anticoagulation mainly includes unfractionated heparin, low-molecular-weight heparin, aspirin, and novel anticoagulants. Combined anticoagulation is commonly a synergistic anticoagulation regimen dominated by heparin drugs, combined with aspirin, different antiplatelet drugs, and expansion agents. Studies indicate that perioperative anticoagulant administration can effectively reduce the risk of thrombosis in free flaps and improve the overall flap survival rate. However, significant differences exist in the impact of drug types, administration routes, initiation timing, and dosage intensity on efficacy and bleeding risk. A unified, standardized application protocol has not yet been established. In addition, there has been a growing number of studies on novel anticoagulant drugs. However, their superiority and optimal application strategies in the field of free flap transplantation still necessitate more high-quality evidence. CONCLUSION Perioperative anticoagulation therapy represents one of the key strategies for improving the survival rate of free flaps. However, there is still a lack of high-level evidence to establish a standard protocol. Future research should focus on the optimization of individualized anticoagulation strategies, the validation of the effectiveness of new anticoagulants, and the exploration of the advantages of different anticoagulation strategies. At the same time, attention should be paid to balancing anticoagulation and bleeding risks to promote the standardization of clinical practice and the improvement of treatment safety.
Humans ; Anticoagulants/therapeutic use* ; Free Tissue Flaps/blood supply* ; Thrombosis/prevention & control* ; Perioperative Care/methods* ; Heparin/therapeutic use* ; Heparin, Low-Molecular-Weight/administration & dosage* ; Perioperative Period ; Aspirin/therapeutic use*

Background: Antiplatelet resistance is one factor that contributes to stroke recurrence among patients with noncardioembolic ischemic strokes. Objectives: This paper aims to describe the prevalence of aspirin and clopidogrel resistance, along with frequency of statin, NSAID and proton pump inhibitor use among our cohort of stroke patients. Method. This is a single-center cross-sectional review that included all adult patients with recurrent noncardioembolic ischemic stroke admitted in a tertiary hospital between January 2019 and June 2023. Results: A total of 1,374 patients were admitted for ischemic stroke from January 2019 to June 2023. Among these, 155 (11.28%) were recurrent noncardioembolic ischemic strokes. Prevalence of aspirin and clopidogrel resistance were 25% and 32.7%, respectively. Clinical profiles of those in the resistant group were comparable with those in the nonresistant group. None of the patients taking aspirin had concomitant use of nonsteroidal antiinflammatory drugs. Only 2 of the patients who were resistant to clopidogrel were on proton pump inhibitors. More than half of the patients both in the resistant and the nonresistant groups were on statin. The study had a small sample size and hence it was not enough to establish causal relationship between factors and antiplatelet resistance. Conclusion More patients were resistant to clopidogrel than to aspirin. Further studies with a bigger sample size are recommended to explore factors that contribute to antiplatelet resistance in Filipino patients.
Aspirin ; Clopidogrel ; Ischemic Stroke ; Tertiary Care Centers

OBJECTIVE: To systematically evaluate the impact of aspirin on the pulmonary inflammatory response in animal models of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). METHODS: Experimental research on aspirin therapy or prevention of ALI/ARDS in animal models were searched in PubMed, Web of Science, Cochrane library, Embase, China biology medicine, CNKI, Wanfang, VIP. The search time limit was from the establishment of the database to July 17, 2023. The control group established the ALI/ARDS model without any pharmacological intervention. The intervention group was given aspirin or aspirin-derived compounds or polymeric-aspirin (Poly-A) at different time points before and after the preparation of the model, of which there was no restriction on the dosage form, dosage, mode of administration, or number of doses. The primary outcome indicators included bronchoalveolar lavage fluid (BALF) or lung tissue myeloperoxidase (MPO) activity, interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and the counts of neutrophils in BALF. Two researchers screened the literature and extracted information based on inclusion and exclusion criteria. Literature quality was assessed by the bias risk assessment tool SYRCLE. RevMan 5.3 software was used for data synthesis and statistical analysis. RESULTS: A total of 17 papers were eventually included, involving a total of 449 animal models, all of which were murine. One paper was at high risk of bias and the rest 16 papers were at moderate risk of bias. Meta-analysis showed that compared with the control group, the neutrophil count in BALF [standardized mean difference (SMD) = -5.06, 95% confidence interval (95%CI) was -7.00 to -3.12, P < 0.000 01], the myeloperoxidase (MPO) activity in BALF or lung tissue (SMD = -3.45, 95%CI was -4.43 to -2.47, P < 0.000 01), the TNF-α level in BALF or lung tissue (SMD = -2.78, 95%CI was -3.58 to -1.98, P < 0.000 01), and the IL-1β level in BALF or lung tissue (SMD = -3.12, 95%CI was -4.56 to -1.69, P < 0.000 1) were significantly decreased in the ALI/ARDS model of the intervention group. CONCLUSIONS Aspirin reduces the level of lung inflammation in animal models of ALI/ARDS. However, there are problems of poor quality and significant heterogeneity of the included studies, which still need our further validation.
Animals ; Acute Lung Injury/drug therapy* ; Aspirin/pharmacology* ; Respiratory Distress Syndrome/drug therapy* ; Disease Models, Animal ; Bronchoalveolar Lavage Fluid/chemistry* ; Tumor Necrosis Factor-alpha/metabolism* ; Interleukin-1beta/metabolism* ; Peroxidase/metabolism* ; Lung/metabolism* ; Neutrophils/drug effects*

BACKGROUND: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. METHODS: We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment. CONCLUSIONS Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
Humans ; Female ; Middle Aged ; ST Elevation Myocardial Infarction/drug therapy* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Cross-Sectional Studies ; Aspirin/therapeutic use* ; Platelet Aggregation Inhibitors/therapeutic use* ; Adrenergic beta-Antagonists/therapeutic use* ; Hospital Mortality ; Registries ; Treatment Outcome ; Percutaneous Coronary Intervention

Omalizumab,as a biological agent targeting IgE,is a recombinant humanized monoclonal antibody and the first targeted drug approved for treating moderate-to-severe bronchial asthma.By reviewing one case of aspirin-induced asthma complicated with nasosinusitis and otitis media,we discussed the value of omalizumab in the treatment of asthma and its complications,aiming to provide a reference for clinical practice.
Humans ; Omalizumab/adverse effects* ; Asthma, Aspirin-Induced ; Asthma/drug therapy* ; Otitis Media/drug therapy*

This study explored the effects of Buyang Huanwu Decoction(BYHWD) on platelet activation and differential gene expression after acute myocardial infarction(AMI). SD rats were randomly divided into a sham-operated group, a model group, a positive drug(aspirin) group, and a BYHWD group. Pre-treatment was conducted for 14 days with a daily oral dose of 1.6 g·kg~(-1) BYHWD and 0.1 g·kg~(-1) aspirin. The AMI model was established using the high ligation of the left anterior descending coronary artery method. The detection indicators included myocardial infarct size, heart function, myocardial tissue pathology, peripheral blood flow perfusion, platelet aggregation rate, platelet membrane glycoprotein CD62p expression, platelet transcriptomics, and differential gene expression. The results showed that compared with the sham-operated group, the model group showed reduced ejection fraction and cardiac output, decreased peripheral blood flow, and increased platelet aggregation rate and CD62p expression, and activated platelets. At the same time, TXB_2 content increased and 6-keto-PGF1α content decreased in serum. Compared with the model group, BYHWD increased ejection fraction and cardiac output, improved blood circulation in the foot and tail regions and cardiomyocytes arrangement, reduced myocardial infarct size and inflammatory infiltration, down-regulated platelet aggregation rate and CD62p expression, reduced serum TXB_2 content, and increased 6-keto-PGF1α content. Platelet transcriptome sequencing results revealed that BYHWD regulated mTOR-autophagy pathway-related genes in platelets. The differential gene expression levels were detected using real-time quantitative PCR. BYHWD up-regulated mTOR, down-regulated autophagy-related FUNDC1 and PINK genes, and up-regulated p62 gene expression. The results demonstrated that BYHWD could regulate platelet activation, improve blood circulation, and protect ischemic myocardium in AMI rats, and its mechanism is related to the regulation of the mTOR-autophagy pathway in platelets.
Rats ; Animals ; Rats, Sprague-Dawley ; Drugs, Chinese Herbal/therapeutic use* ; Myocardial Infarction/genetics* ; Myocardium/metabolism* ; Aspirin/therapeutic use* ; TOR Serine-Threonine Kinases/metabolism* ; Membrane Proteins/metabolism* ; Mitochondrial Proteins

Humans ; Aspirin/therapeutic use* ; Cardiovascular Diseases/prevention & control* ; Platelet Aggregation Inhibitors/therapeutic use* ; Risk Assessment ; Mass Screening