Combination Of Acetylsalicylic Acid Research Articles

The Net Clinical Outcome of Dual-Pathway Inhibition in Clinical Practice: The "Xarelto plus Acetylsalicylic Acid: Treatment Patterns and Outcomes in Patients with Atherosclerosis" Registry.

Background: In the COMPASS trial, the combination of acetylsalicylic acid (ASA) plus 2.5 mg rivaroxaban twice daily (dual-pathway inhibition, DPI) has been shown to be superior to ASA monotherapy for the reduction in ischemic major adverse cardiovascular events (MACEs, i.e., cardiovascular death, stroke, or myocardial infarction). Methods: The international XATOA registry (Xarelto plus Acetylsalicylic acid: Treatment patterns and Outcomes in patients with Atherosclerosis) is a prospective post-approval registry that investigates the cardiovascular outcomes of patients taking ASA plus 2.5 mg rivaroxaban. The aim of this pre-specified analysis was to determine the net clinical outcome (NCO), i.e., a combination of MACEs and bleeding events, of DPI in patients from daily clinical practice. Results: Among the 5615 patients, the presence of multiple risk factors resulted in an increase in the total risk of experiencing an NCO event, e.g., from 1.27% (one risk factor) to 2.18% (two risk factors) and 4.07% (three or more risk factors), respectively, with ischemic MACE representing the primary driver of bleeding complications. Conclusions: In the real-world XATOA registry, the annual rate of NCO events was low and numerically similar to those seen in the treatment group in the randomized COMPASS trial.

Analysis of maternal-fetal complications associated with preeclampsia. Literature review

Objective: Identify maternal-fetal complications associated with preeclampsia. Method: the research was developed through a documentary review, a descriptive study, with a qualitative approach around maternal-fetal complications due to preeclampsia. It was investigated in high-impact databases such as: PubMed, Scielo, Scopus, Dimensions and the Google Scholar search engine. Inclusion criteria will be applied such as articles from the last 5 years, between 2018 and 2023, original articles in Spanish and English. The bibliographic review was developed with ten bibliographic sources. Results: It was identified that young women, especially between 20 and 34 years old, face a higher risk of preeclampsia, therefore, early detection is key and could be implemented in settings with limited resources. Furthermore, attention to risk factors, such as chronic hypertension, is vital, and the combination of acetylsalicylic acid and calcium is suggested in high-risk women as a pharmacological approach. Conclusion: It is revealed that there are significant maternal-fetal complications, such as high blood pressure and proteins in the urine, with serious consequences for the health of mother and child.

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

Diamine Oxidase Interactions with Anti-Inflammatory and Anti-Migraine Medicines in the Treatment of Migraine

Histamine intolerance arises when there is a disparity between the production of histamine and the body’s ability to break it down. In the gastrointestinal tract, the primary enzyme responsible for metabolizing ingested histamine is diamine oxidase (DAO), and a shortage of this enzyme has been associated with some diseases related to the respiratory, cardiovascular, nervous, muscular, and digestive systems, in addition to migraines. The treatment of migraines typically revolves around the utilization of both anti-migraine and anti-inflammatory drugs, but their interaction with DAO is not thoroughly understood. In this study, we examined the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) and anti-migraine medications on DAO activity through in vitro experiments. We also investigated their effects on the human intestinal cell line Caco-2, assessing changes in DAO expression (both at the mRNA and protein levels) as well as DAO activity. The tested drugs, including ibuprofen, acetylsalicylic acid, paracetamol, a combination of acetylsalicylic acid with paracetamol and caffeine, zolmitriptan, and sumatriptan, did not inhibit DAO activity or reduce their levels. However, naproxen reduced DAO protein levels in human enterocyte cultures while not affecting DAO activity. These results suggest that combining anti-inflammatory and anti-migraine drugs with DAO enzyme supplementation for migraine patients with DAO deficiency could be beneficial for healthcare professionals in their daily practice.

Morphological determinants for the local hemostatic effect of exogenous fibrin monomer in its systemic administration after injury with inhibition of platelet aggregation in the experiment

Background. In our previously published studies, we demonstrated a high hemostatic activity of a low dose of exogenous fibrin monomer during its systemic administration in a model of dosed liver injury with preliminary inhibition of platelet aggregation. However, the analysis of platelet involvement in the mechanisms of local fibrin formation has not been analyzed. The aim of the study. To conduct a comparative analysis of the cellular composition of venous and wound blood, as well as blood in the wound vessels to assess the contribution of platelets to the hemostatic effect of exogenously administered fibrin monomers in dosed liver injury under conditions of pharmacologically determined thrombocytopathy. Methods. In a model of dosed liver injury in rabbits after inhibition of platelet aggregation by acetylsalicylic acid in combination with clopidogrel, the effect of the administration of fibrin monomer was evaluated in comparison with the use of tranexamic acid. We studied the number of platelets in venous and wound blood smears, as well as in the contents of wound vessels. Results. It has been established that with the systemic administration of exogenous fibrin monomer, the number of platelets in wound blood smears decreases by 17.2 % in comparison with free circulating venous blood. Platelets in wound blood form aggregates and are in an activated state. In the wound vessels, the number of these cells was maximum (150 per lower field) compared with the number of platelets in the placebo and tranexamic acid groups (55 and 84 per lower field, respectively). Also in the wound blood, erythrocytes with altered forms (echinocytes, schistocytes, stomatocytes and ovalocytes) were found. Conclusion. Systemic administration of exogenous fibrin monomer affects the redistribution of platelets between the systemic circulation, wound vessels and wound blood, determining its hemostatic effect and local wound fibrin formation in dosed liver injury. The presence of receptor-mediated platelets recruitment due to fibrin monomer in the wound vessels with the participation of damaged erythrocytes is assumed.

Pharmacological Effects of a New Soluble Guanylate Cyclase Stimulator in Experimental Ischemic Stroke.

We studied the action of a new indolinone derivative GRS, acetylsalicylic acid (ASA), and their combination on platelet aggregation, vasodilatory endothelial function, neurological status, and cerebral infarction area in experimental focal cerebral ischemia/reperfusion in rats. GRS compound (10 mg/kg), ASA (10 mg/kg), and their combination in the same doses were administered orally once a day as a suspension in 1% starch solution over 5 days after pathology modeling. Sham-operated and control animals were administered 1% starch solution. On day 5 after pathology modeling, platelet aggregation and brain damage area were studied in a half of rats in each group, and the vasodilatory function of the endothelium was studied in the other half. Neurological deficit was assessed 4 h and 1, 3, and 5 days after pathology modeling. GRS compound and ASA equally effectively prevent platelet aggregation and the development of neurological deficit in rats. GRS compound restores the vasodilatory effects of the endothelium, but only ASA contributes to reduction of the cerebral infarction area. In case of combined administration, GRS and ASA do not exhibit synergy in their antiaggregant effect.

Effects of Antiplatelet Drugs on Platelet-Dependent Coagulation Reactions.

Activated platelets are involved in blood coagulation by exposing phosphatidylserine (PS), which serves as a substrate for assembling coagulation complexes. Platelets accelerate fibrin formation and thrombin generation, two final reactions of the coagulation cascade. We investigated the effects of antiplatelet drugs on platelet impact in these reactions and platelet ability to expose PS. Washed human platelets were incubated with acetylsalicylic acid (ASA), ticagrelor, ASA in combination with ticagrelor, ruciromab (glycoprotein IIb-IIIa antagonist), or prostaglandin E1 (PGE1). Platelets were not activated or activated by collagen and sedimented in multiwell plates, and plasma was added after supernatant removal. Fibrin formation (clotting) was monitored in a recalcification assay by light absorbance and thrombin generation in a fluorogenic test. PS exposure was assessed by annexin V staining using flow cytometry. Ticagrelor (alone and in combination with ASA), ruciromab, and PGE1, but not ASA, prolonged the lag phase and decreased the maximum rate of plasma clotting and decreased the peak and maximum rate of thrombin generation. Inhibition was observed when platelets were not treated with exogenous agonists (activation by endogenous thrombin) and pretreated with collagen. Ticagrelor (alone and in combination with ASA), ruciromab, and PGE1, but not ASA, decreased PS exposure on washed platelets activated by thrombin and by thrombin + collagen. PS exposure on activated platelets in whole blood was lower in patients with acute coronary syndrome receiving ticagrelor + ASA in comparison with donors free of medications. These results indicate that antiplatelet drugs are able to suppress platelet coagulation activity not only in vitro but also after administration to patients.

Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases.

Background: Patients with multiple sclerosis (MS) often undergo complex treatment regimens, resulting in an increased risk of polypharmacy and potential drug-drug interactions (pDDIs). Drug interaction databases are useful for identifying pDDIs to support safer medication use. Objective: To compare three different screening tools regarding the detection and classification of pDDIs in a cohort of MS patients. Furthermore, we aimed at ascertaining sociodemographic and clinical factors that are associated with the occurrence of severe pDDIs. Methods: The databases Stockley’s, Drugs.com and MediQ were used to identify pDDIs by screening the medication schedules of 627 patients. We determined the overlap of the identified pDDIs and the level of agreement in pDDI severity ratings between the three databases. Logistic regression analyses were conducted to determine patient risk factors of having a severe pDDI. Results: The most different pDDIs were identified using MediQ (n = 1,161), followed by Drugs.com (n = 923) and Stockley’s (n = 706). The proportion of pDDIs classified as severe was much higher for Stockley’s (37.4%) than for Drugs.com (14.4%) and MediQ (0.9%). Overall, 1,684 different pDDIs were identified by at least one database, of which 318 pDDIs (18.9%) were detected with all three databases. Only 55 pDDIs (3.3%) have been reported with the same severity level across all databases. A total of 336 pDDIs were classified as severe (271 pDDIs by one database, 59 by two databases and 6 by three databases). Stockley’s and Drugs.com revealed 47 and 23 severe pDDIs, respectively, that were not included in the other databases. At least one severe pDDI was found for 35.2% of the patients. The most common severe pDDI was the combination of acetylsalicylic acid with enoxaparin, and citalopram was the drug most frequently involved in different severe pDDIs. The strongest predictors of having a severe pDDI were a greater number of drugs taken, an older age, living alone, a higher number of comorbidities and a lower educational level. Conclusions: The information on pDDIs are heterogeneous between the databases examined. More than one resource should be used in clinical practice to evaluate pDDIs. Regular medication reviews and exchange of information between treating physicians can help avoid severe pDDIs.

Periphere arterielle Verschlusskrankheit bei Menschen mit Diabetes

Due to the increasing number of patients with diabetes and the aging of society, the number of patients with diabetes and peripheral arterial occlusive disease (PAOD) is constantly increasing. Diabetes is a major risk factor for the development and progression of PAOD and the combination of both diseases worsens the prognosis. Timely diagnosis and therapy appropriate to the clinical stage are important. Comparable to other atheromatous vascular diseases, treatment of vascular risk factors is essential. The cornerstones of treatment are structured exercise training, antiplatelet drugs, and statins. The combination of acetylsalicylic acid (aspirin) and rivaroxaban is a further option for vascular patients at high risk for ischemia. In patients with diabetes, the long-term results of revascularization are often unsatisfactory. Therefore, the indication for either endovascular therapy or open surgery must be narrowly defined in the stage of claudication. In the case of critical limb-threatening ischemia revascularization must be immediately done.

The Advantages of Dual Antiplatelet Therapy Combinations in Predicting Recurrent Cardiovascular Events in Obese Patients after Myocardial Infarction

The purpose of the study was to analyze the incidence of recurrent cardiovascular events in obese patients after a myocardial infarction during a 6-month follow-up period, depending on the combination of ticagrelor or clopidogrel with acetylsalicylic acid as a part of dual antiplatelet therapy. Materials and methods. The study involved 75 patients with acute myocardial infarction with ST segment elevation and concomitant obesity. The patients were divided into 2 subgroups: the first included 31 patients who received the combination of acetylsalicylic acid and ticaglelor, and the second – 44 patients treated with the combination of acetylsalicylic acid and clopidogrel in dual antiplatelet therapy. The GRACE scale was used to stratify the risk of hospital and 6-month mortality. Control of the recurrent cardiovascular events presence was carried out after 6 months. Results and discussion. Acute myocardial infarction with ST elevation is still the main cause of mortality and invalidisation of able-bodied population. Regardless of the primary percutaneous coronary intervention or thrombolysis, dual antiplatelet therapy remains the main therapeutic strategy, both in the acute ST-elevation myocardial infarction period and in the remote – for the secondary prevention of possible adverse cardiovascular events, and is a combination of acetylsalicylic acid and a P2Y12 receptor inhibitor. To date, the issue of the choice of a P2Y12 receptor inhibitor in the dual antiplatelet therapy that is used in the treatment of ST-elevation myocardial infarction is an urgent subject of scientific discussion. While observing patients after a myocardial infarction with concomitant obesity over a period of 6 months, it was found that 28 patients had a recurrent myocardial infarction and / or unstable angina, which was 37.56% of all patients. The analysis of the GRACE scale scores in a cohort of patients with recurrent cardiovascular events revealed that all patients were included in high risk group (> 118 points). In the group of patients who received dual antiplatelet therapy with the involvement of acetylsalicylic acid and ticagrelor in 11 people recorded a repeated myocardial infarction and / or unstable angina, which was 14.76%. At the same time, in a group of patients receiving dual antiplatelet therapy in a combination of acetylsalicylic acid with clopidogrel, re-cardiovascular catastrophes were detected in 17 patients, which was 22.8% of all patients with ST-elevation myocardial infarction on the background of concomitant obesity. Conclusion. The patients with obesity after a myocardial infarction who are included in the GRACE high risk group are recommended to be treated with the combination of acetylsalicylic acid and ticagrelor as a result of a notable reduction in the risk of recurrent cardiovascular catastrophes compared with the combination of acetylsalicylic acid and clopidogrel

Long-term outcomes of coronary artery bypass graft surgery in patients with widespread atherosclerotic lesions of the coronary and peripheral vascular basins (based on the REGATA long-term antithrombotic therapy registry)

Introduction . Multifocal atherosclerosis (MFA) in patients with CHD is a key risk factor for thrombotic complications (TC). There are little data on the long-term prognosis in patients with multivessel CHD combined with carotid artery lesions. Objective . To assess prognostic negative outcomes (thrombosis and bleeding) in patients with CHD and MFA undergoing revascularization procedures – coronary artery bypass graft surgery and, in case of high risk of ischemic stroke, carotid endarterectomy. Materials and methods . A total of 189 patients with stable multivessel coronary artery disease who successfully underwent coronary bypass graft surgery and had concomitant atherosclerosis of the carotid arteries ≥50% were included in the study. The exclusion criterion was chronic use of oral anticoagulants. The choice of antithrombotic therapy after the surgical intervention was determined by the attending physicians. The efficacy endpoint was defined as the sum of TC including cardiovascular death, acute coronary syndrome, ischemic stroke, acute lower limb ischemia, and the need for emergency revascularization of the carotid or coronary basins. BARC bleeding types 2-5 were considered as a safety endpoint. Results . The median follow-up period was 37 months. [MR 25.0; 45.0]. The cumulative incidence of TC was 11.1%, BARC 2-5 bleeding was 4.8%. One or two antiplatelet agents were prescribed at discharge in 87.3% of cases, and in 12.7% – a combination of acetylsalicylic acid (ASA) and oral anticoagulant (OAC) for up to 6 months. The incidence of thrombotic complications was not significantly different in the mono- or dual antiplatelet therapy groups. The combination therapy group (OAC + ASA) was characterized by the highest number of comorbidities. When analyzing the TC for the first 6 months. (before anticoagulant withdrawal) there was no significant difference between the groups of antiplatelet therapy and the combination of ASA and OAC (Log-Rank, p = 0.4669). The proportion of patients who survived the entire follow-up period without developing TC was significantly higher in the group compared to the initial combination therapy group: 0.83 versus 0.50 (Log-Rank, p = 0.0101). Conclusion . Despite complete revascularization, the incidence of TC during the two years of follow-up was high. In the combination therapy group, anticoagulant withdrawal led to an increased incidence of TC.

STUDY THE FUNCTIONAL ACTIVITY OF PLATELETS AGAINST THE BACKGROUND OF ANTIPLATELET THERAPY IN PATIENTS OF THE CARDIOLOGICAL HOSPITAL

Antiplatelet drugs are widely used in clinical practice to reduce the risk of adverse cardiovascular events in patients with cardiovascular diseases. It is noted that resistance to antiplatelet agents is determined in a number of patients, which may increase the risk of cardiovascular catastrophes. Given the importance of the antiplatelet component in preventive and therapeutic strategies, the inability to achieve its potential benefit in patients with atherothrombosis is an important clinical problem. Aim of the study. Studying the features of platelet aggregation in vitro in patients with coronary heart disease, acute disorders of cerebral circulation and acute coronary syndrome receiving acetylsalicylic acid or acetylsalicylic acid in combination with clopidogrel during hospital treatment. Materials and methods. The subjects were divided into 3 groups: 1 - patients of the Department of Cardiology - received acetylsalicylic acid - Cardiomagnil ® a dose of 75 mg / day; group 2 - Departments of acute coronary syndrome - took acetylsalicylic acid - Acecardol ® - 100 mg once a day in combination with clopidogrel – 75 mg per day; group 3 - patients of the Department of patients with acute disorders of cerebral circulation took Acecardol ® 100 mg once a day. Platelet aggregation activity was studied in all patients after 5 days of regular intake of antiplatelet agents. Platelet aggregation was studied by optical aggregatometry using a laser aggregometer «Biola». As agonists of aggregation were used: ADP (up to 5 mmol/L), epinephrine (10 mg/ml), collagen (1 mg/ml) and ristocetin (ristomycin) (15 mg/ml). Results and discussion. Insufficient effect on the background of taking antiplatelet agents was observed in 27.2% of cases in patients of group 1 and 8.2% in patients of group 2 (p=0.0034). In patients with acute disorders of cerebral circulation (group 3), the insufficient effect of acetylsalicylic acid was noted in 16.3% of cases, which was significantly less than in group 1 (p=0.026). Patients with acute coronary syndrome receiving double antiplatelet therapy achieved pronounced suppression of aggregation in 54% of cases, which was statistically significantly more than in group 1 - 23.3% (p=0.0004). In patients of group 3, a pronounced antiplatelet effect was observed in 41.2% of cases, which was significantly more than in patients of group 1 (p=0.0054). Thus, the use of acetylsalicylic acid in combination with clopidogrel in patients with acute coronary syndrome provided a more pronounced suppression of platelet aggregation. This is consistent with the data of other researchers who found that in 6% of patients with the use of two antiplatelet agents, the desired result was not obtained [14, 15]. It was noted that in patients with acute cerebrovascular accident who received only acetylsalicylic acid, platelet aggregation decreased to a greater extent than in patients with coronary heart disease (group 1). Perhaps this is due to the fact that patients of these groups received different medications of acetylsalicylic acid. Findings. The use of two antiplatelet agents does not always lead to optimal effect. In this regard, the expediency of aggregatometry to assess the effect of acetylsalicylic acid is obvious. Particular attention should be paid to patients receiving acetylsalicylic acid an outpatient basis, since the low effectiveness of antiplatelet therapy increases the risk of myocardial infarction, stroke.

A retrospective review of antiphospholipid syndrome from a South Asian country.

Objectives This study aims to investigate clinical presentations, antiphospholipid antibody patterns and their levels, therapeutic regimens, and outcomes in patients with antiphospholipid syndrome (APS) admitted to a tertiary care hospital of a South Asian country.Patients and methods Between January 2009 and December 2019, a total of 216 patients with APS (8 males, 208 females; median age: 35.7±6.9 years; range, 20 to 76 years) who either fulfilled the modified Sydney criteria or those who satisfied only clinical criteria along with positive antiphospholipid antibody on at least one occasion (probable APS) were retrospectively analyzed.Results The majority of the patients (n=183, 84.7%) had obstetric complications, followed by venous thrombosis in 23 (10.8%) patients. Recurrent early abortions in 126 (58.6%) and deep venous thrombosis in 16 (7.4%) patients were the most prevalent obstetrical and venous events, respectively, whereas limb gangrene in seven (3.3%) and ischemic stroke in seven (3.3%) were the most common arterial events. A total of 190 (88%) patients had primary APS, while 26 (12%) had secondary APS. Systemic lupus erythematosus was the frequent association with secondary APS found in 19 (73%) patients. Immunoglobulin M (IgM) anticardiolipin antibody was present in 173 (65.0%) patients, being the most commonly reported antibody. Probable catastrophic APS was found in four (1.9%) patients. Majority of the patients (n=190, 87.9%) were treated with a combination of acetylsalicylic acid and low-molecular-weight heparin. Single mortality was observed in our study population due to complications related to catastrophic APS.Conclusion Antiphospholipid syndrome has a wide range of thrombotic and obstetrical manifestations with important variations in different regions of the world. There is a significant morbidity and mortality related to APS, despite treatment with anticoagulation and; therefore, describing prognostic markers and optimal therapeutic interventions is pivotal to prevent complications.

Вибір оптимального інгібітору протонної помпи для пацієнтів з ішемічною хворобою серця, які потребують проведення подвійної антитромбоцитарної терапії

Висока захворюваність і смертність від серцево-судинних захворювань призвели до необхідності широкого використання антитромбоцитарних засобів у клінічній практиці. Найбільш перспективною вважається комбінована антиагрегантна терапія з використанням препаратів, що мають різні механізми впливу на тромбоцитарну ланку гемостазу, за рахунок чого можна досягти вираженого синергічного ефекту. У нашій країні переважно призначається комбінація ацетилсаліцилової кислоти і клопідогрелю, яку часто називають подвійною антитромбоцитарною терапією (ПАТ). Для зменшення ризиків розвитку шлунково-кишкових ускладнень при використанні ПАТ рекомендований прийом інгібіторів протонної помпи (ІПП), проте в деяких дослідженнях згадується, що одночасне призначення ІПП та клопідогрелю в перспективі підвищує ризик виникнення несприятливих серцево-судинних подій, до яких відносять інфаркт міо-карда, інсульт, нестабільну стенокардію, необхідність повторних коронарних втручань і коронарну смерть. У зв’язку з цим представляється актуальною проблема розробки підходів диференційованого застосування ІПП у пацієнтів, які отримують ПАТ. Надано огляд літератури з означеної вище проблематики, наведено результати досліджень із вивчення впливу різних ІПП на клінічні наслідки у хворих, які приймають клопі-догрель.

Zero Mother Mortality Preeclampsia Program: Opportunity for a Rapid Acceleration in the Decline of Maternal Mortality Rate in Indonesia

Objectives: Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia. Materials and Methods: The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel. Results: Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance. Conclusions: The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.

Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease.

Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a "vascular" dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.

Effect of combined acetylsalicylic acid and statins treatment on intracranial aneurysm rupture.

Acetylsalicylic acid (ASA) and statins have been identified as potentially reducing the risk of intracranial aneurysms (IA) rupture. We aim to determine the effect of this drugs on the risk of rupture of IA. We performed a retrospective cohort study from a prospective database of patients with IA treated in our institution between January 2013 and December 2018. Demographics, previous oral treatments, presence of multiple aneurysms, size of aneurysm, lobulation, location and morphology of the aneurysms were recorded. Patients were dichotomized as ruptured and unruptured IA. A total of 408 IA were treated, of which 283 (68.6%) were in women. The median age was 53, 194 (47.5%) were ruptured IA. 38 patients (9.3%) were receiving ASA and 84 (20.6%) were receiving statins at the moment of the IA diagnosis. In the multivariable regression analysis, ASA plus statin use and multiple aneurysms were independently associated with unruptured IA (OR 5.01, 95% CI, 1.37-18.33, P = 0.015 and OR 2.72, 95% CI 1.68-4.27, P<0.001, respectively). Whereas, lobulated wall aneurysm and PComA/AComA location were inversely and independently associated with unruptured IA condition (OR 0.34, 95% CI 0.21-0.55, P<0.001 and OR 0.37, 95% CI 0.23-0.60, P<0.001, respectively). However, ASA and statins in monotherapy were not independently associated with unruptured IA condition. In our study population ASA plus statins treatment is independently associated with unruptured IA. Larger and prospective studies are required to explore this potential protective effect against IA rupture.

Early discontinuation of dual antiplatelet therapy via acetylsalicylic acid cessation in patients with acute coronary syndrome undergoing percutaneous coronary interventions to reduce the bleeding risk

Early percutaneous coronary intervention (PCI) and long-term aggressive antithrombotic treatment based on dual antiplatelet therapy (DAPT) are the most important elements in the treatment of patients with acute coronary syndrome (ACS). The most studied and recommended for ACS is the 12-month DAPT (combination of acetylsalicylic acid (ASA) and P2Y 12 receptor antagonist). Bleeding events due to DAPT after ACS and after PCI forced the search for approaches aimed at reducing the risk of such complications, especially noticeable when using a powerful blocker of the P2Y 12 receptor of platelets. One of the recently identified solutions turned out to be early (1-3 months after the therapy initiation) discontinuation of ASA with continued administration of one antiplatelet agent (P2Y 12 receptor antagonist). The article provides arguments in favor of this approach.

Cardiovascular Disease Continuum

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.

MORPHOLOGICAL CHANGES OF THE GASTRIC MUCOSA WHILE USING ANTIAGGREGANTS AND PANTOPRAZOLE (AN EXPERIMENTAL STUDY)

The aim: Was to characterize the morphological peculiarities of the gastric mucosa at early stage of prescription of acetylsalicylic acid (ASA) and clopidogrel as well as to study the impact of pantoprazole on the gastric mucosa to optimize the prophylaxis and treatment of gastropathies induced by ASA and clopidogrel. Materials and methods: The experiments were performed on 77 non-linear white male rats with the average weight of 150-180 g. Depending on the aim of research, the animals were divided into 7 groups. Results: The administration of pantoprazole in combination with ASA and clopidogrel presented positive trends in neutral glycoproteins amount and contributes to preventing GM necrotic lesions by amplification of protective properties of mucus and stabilization of apoptotic activity of gastric epithelial cells. Conclusions: 1. According to our study findings, administration of ASA in combination with clopidogrel results in 2,5 times higher risk of GM erosive lesions. 2. One of the most significant morphological manifestations of gastropathy in ASA and clopidogrel regimen is the development of microerosions, which are poorly diagnosed by macroscopic examination. 3. The use of PAS-reaction makes possible to identify damage to the basal membrane of superficial epitheliocytes, which may be a top-priority morphological criterion of gastropathy induced by ASA or clopidogrel in the absence of an inflammatory reaction. 4. Administration of pantoprazole in combination with ASA and clopidogrel contributes to preventing GM necrotic lesions by amplification of protective properties of mucus and stabilization of apoptotic activity of gastric epithelial cells.