Low-dose Aspirin Therapy Research Articles

New and treatment-relevant risk stratification for thrombosis in essential thrombocythemia and polycythemia vera.

New and treatment-relevant risk stratification for thrombosis in essential thrombocythemia and polycythemia vera.

Is low-dose aspirin therapy to prevent preeclampsia more efficacious in non-obese women or when initiated early in pregnancy?

Objective: Late timing of intervention and maternal obesity are potential explanations for the modest effect of aspirin for preeclampsia prevention. We explored whether low-dose aspirin (LDA) is more effective in women at increased risk when initiated before 16 weeks' gestation or given to non-obese women.Methods: Secondary analysis of a trial to evaluate LDA (60 mg/d) for preeclampsia prevention in high-risk women. Participants were randomized to LDA or placebo between 13 and 26 weeks. We stratified the effect of LDA on preeclampsia by (a) timing of randomization (< 16 or ≥ 16 weeks gestation) and (b) body mass index (BMI) class (non-obese and obese). The Breslow–Day test for homogeneity was used to assess for variations in effect of LDA across gestational age and BMI groups.Results: Of 2503 women, 461 (18.4%) initiated LDA < 16 weeks. LDA effect was not better when initiated < 16 weeks (RR: 0.93, 95% CI: 0.67–1.31) versus ≥ 16 weeks (RR: 0.90, 95% CI: 0.75–1.08), (p value for interaction = 0.87). Similarly, LDA effect was not better in non-obese (RR: 0.91, 95% CI: 0.7–1.13) versus obese women (RR: 0.89, 95% CI: 0.7–1.13), (p value for interaction = 0.85).Conclusion: LDA for preeclampsia prevention was not more effective when initiated < 16 weeks or used in non-obese women at risk for preeclampsia. No particular subgroup of women was more or less likely to benefit from LDA therapy.

Effects of Low-Dose Aspirin Therapy on Thermoregulation in Firefighters.

BackgroundHeart attack is the most common cause of line-of-duty death in the fire service. Daily aspirin therapy is a preventative measure used to reduce the morbidity of heart attacks but may decrease the ability to dissipate heat by reducing skin blood flow.MethodsIn this double-blind, placebo-controlled, crossover study, firefighters were randomized to receive 14 days of therapy (81-mg aspirin or placebo) before performing treadmill exercise in thermal-protective clothing in a hot room [38.8 ± 2.1°C, 24.9 ± 9.1% relative humidity (RH)]. Three weeks without therapy was provided before crossing to the other arm. Firefighters completed a baseline skin blood-flow assessment via laser Doppler flowmetry; skin was heated to 44°C to achieve maximal cutaneous vasodilation. Skin blood flow was measured before and after exercise in a hot room, and at 0 minutes, 10 minutes, 20 minutes, and 30 minutes of recovery under temperature conditions (25.3 ± 1.2°C, 40.3 ± 13.7% RH). Platelet clotting time was assessed before drug administration, and before and after exercise.ResultsFifteen firefighters completed the study. Aspirin increased clotting time before and after exercise compared with placebo (p = 0.003). There were no differences in absolute skin blood flow between groups (p = 0.35). Following exercise, cutaneous vascular conductance (CVC) was 85 ± 42% of maximum in the aspirin and 76 ± 37% in the placebo groups. The percentage of maximal CVC did not differ by treatment before or after recovery. Neither maximal core body temperature nor heart rate responses to exercise differed between trials.ConclusionThere were no differences in skin blood flow during uncompensable heat stress following exercise after aspirin or placebo therapy.

Aspirin Ingestion Does Not Influence Local Sweat Responses during Exercise or Recovery in the Heat

Low-dose aspirin (ASA) therapy has been shown to alter skin blood flow responses and body temperature during heat stress in middle-aged participants. However, limited research has investigated the influence of aspirin on local sweat responses during continuous exercise and during passive recovery in the heat. PURPOSE: To investigate if, during exercise and/or recovery in the heat, acute ingestion of standard U.S. full-dose (325 mg) or low-dose (81 mg) ASA would alter indices of local sweat rate (SR). METHODS: Seven, healthy male participants (mean ± SD; 27 ± 5 years) completed counter-balanced trials to compare ASA treatments (325 mg ASA and 81 mg ASA) to a control trial (no ASA). A 10 day washout period was used to ensure normal blood platelet restoration between ASA treatments. Participants performed recumbent cycling in the heat (35 °C; 30-40% rH) for 45 min at an intensity initially corresponding to 50% heart rate reserve, followed by a 15 min passive recovery. A capacitance hygrometry capsule was placed on the dorsal aspect of participants forearm and used to continuously measure changes in local SR. RESULTS: ASA did not affect the onset of sweating with respect to core temperature (325 mg, 36.8 ± 0.3 °C; 81 mg, 36.8 ± 0.3 °C; control, 36.8 ± 0.4 °C; P = 0.82), SR sensitivity [(mg·cm−2·min−1)/°C] (325 mg, 0.69 ± 0.20; 81 mg, 0.67 ± 0.22; control, 0.69 ± 0.28; P = 0.94), or peak SR (mg·cm−2·min−1) (325 mg, 0.95 ± 0.24; 81 mg, 0.89 ± 0.18; control, 0.93 ± 0.26; P = 0.42) during exercise. Additionally, ASA did not appear to alter local SR among trials when expressed as percent change (%[INCREMENT]) from the cessation of exercise until the end of passive recovery (325 mg, −45 ± 21%; 81 mg, −53 ± 19%; control, −48 ± 26%; P = 0.70). CONCLUSION: Acute ASA ingestion did not affect thermoregulatory responses during submaximal exercise or passive recovery under the conditions of this investigation. Given the relatively youthful age and health status of present cohort, future research should seek to evaluate the influence of ASA on populations known to be at risk for heat-related illness (e.g., type 2 diabetes, spinal cord injury).

Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?

Cohort. To compare the perioperative morbidity of patients with cardiac stents after spine surgery who continue to take aspirin before and after the operation with a similar group of patients who preoperatively discontinued aspirin. The preoperative discontinuation of anticoagulant therapy has been the standard of care for orthopedic surgical procedures. However, recent literature has demonstrated significant cardiac risk associated with aspirin withdrawal in patients with cardiac stents. Although it has recently been demonstrated that performing orthopedic surgery while continuing low-dose aspirin therapy seems to be safe, studies focused on spinal surgery have not yet been performed. Because of the risk of intraspinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression, spinal surgeons have been reluctant to operate on patients taking aspirin. This institutional review board-approved study included 200 patients. Preoperative parameters and postoperative outcome measures were analyzed for 100 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy and 100 patients who continued to take daily aspirin through the perioperative period. The primary outcome measure was serious bleeding-related postoperative complications such as spinal epidural hematoma. The operative time, intraoperative estimated blood loss, hospital length of stay, transfusion of blood products, and 30-day hospital readmission rates were also recorded and compared. The patients who continued taking aspirin in the perioperative period had a shorter hospital length of stay on average (4.1 ± 2.7 vs. 6.2 ± 5.8; P < 0.005), as well as a reduced operative time (210 ± 136 vs. 266 ± 143; P < 0.01), whereas there was no significant difference in the estimated blood loss (642 ± 905 vs. 697 ± 1187), the amount of blood products transfused, overall intra- and postoperative complication rate (8% vs. 11%), or 30-day hospital readmission rate (5% vs. 5%). No clinically significant spinal epidural hematomas were observed in either of the study groups. The current study has observed no appreciable increase in bleeding-related complication rates in patients with cardiac stents undergoing spine surgery while continuing to take aspirin compared with patients who discontinued aspirin prior to surgery. Although very large studies will be needed to determine whether aspirin administration results in a small complication rate increase, the current study provides evidence that perioperative aspirin therapy is relatively safe in patients undergoing spinal surgery. 2.

Myeloproliferative Neoplasms: A Contemporary Review.

Polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) constitute the BCR-ABL1-negative myeloproliferative neoplasms and are characterized by mutually exclusive Janus kinase 2 (JAK2), calreticulin (CALR), and myeloproliferative leukemia virus oncogene (MPL) mutations; respective frequencies of these mutations are approximately 95%, 0%, and 0% in PV, 60%, 20%, and 3% in ET, and 60%, 25%, and 7% in PMF. These mutations might be accompanied by other mutations that are less specific to myeloproliferative neoplasms but are prognostically relevant, such as additional sex combs-like 1 (ASXL1). Characteristic bone marrow morphology is required for World Health Organization-compliant diagnosis, especially in distinguishing ET from prefibrotic PMF and masked PV. Survival is the longest in ET, although still inferior to that of the age- and sex-matched control population; median survivals for patients younger than 60 years are approximately 33 years for ET, 24 for PV, and 15 for PMF. Major disease complications include thrombosis and leukemic or fibrotic transformation. In PV and ET, risk factors for survival include older age, leukocytosis, and thrombosis, whereas JAK2 mutation in ET is associated with increased risk of thrombosis. In PMF, type 1 or type 1-like CALR mutations are associated with superior and ASXL1 with inferior survival. Prevention of thrombosis in PV is secured by phlebotomy (hematocrit target &lt;45%) and in both PV and ET by low-dose aspirin therapy; high-risk patients derive additional antithrombotic benefit from cytoreductive therapy with hydroxyurea as first-line and interferon-alfa and busulfan as second-line drugs of choice. Although the JAK inhibitor ruxolitinib was recently approved for use in hydroxyurea-resistant PV, its role in routine clinical practice remains debatable. In myelofibrosis, stem cell transplant is the current treatment of choice for genetically or clinically high-risk disease; for all other patients requiring treatment, participation in clinical trials may be preferred because currently available drugs, including JAK inhibitors, are palliative and not shown to be disease modifying.

Risk of bleeding after endoscopic submucosal dissection for colorectal tumors in patients with continued use of low-dose aspirin.

Although Japanese guidelines proposed by the Japan Gastroenterological Endoscopy Society for endoscopic submucosal dissection (ESD) for colorectal tumors recommend continued use of low-dose aspirin (LDA), this strategy is controversial. It was our practice to interrupt LDA therapy 5-7 days before ESD until December 2010, when we instituted the new guidelines and performed ESD without interrupting LDA therapy. The aim of the present study was to confirm the validity of the noninterrupted use of LDA inpatients undergoing ESD for colorectal tumors. We studied 582 consecutive patients with 609 colorectal tumors who underwent ESD at Hiroshima University Hospital between January 2006 and July 2014. The patients comprised three groups: LDA-interrupted group (13 patients with 13 colorectal tumors), LDA-continued group (28 patients with 31 colorectal tumors), and no anticoagulant/antiplatelet group (541 patients with 565 colorectal tumors). The en bloc resection rate was 100% (13/13) in the LDA-interrupted group and 90.3% (28/31) in the LDA-continued group. Incidences of poor bleeding control during the procedure and bleeding after the procedure were 7.7% (1/13) and 15.4% (2/13) of patients, respectively, in the LDA-interrupted group, and 3.2% (1/31) and 16.1% (5/31) of patients, respectively, in the LDA-continued group. No patients experienced ischemic events in the perioperative period. Our data suggest that continued use of LDA increased the risk of bleeding after ESD for colorectal tumors compared with nonuse of anticoagulant/antiplatelets. No significant difference was seen between the LDA-continued group and the LDA-interrupted group.

Long-term efficacy and safety of rabeprazole in patients taking low-dose aspirin with a history of peptic ulcers: a phase 2/3, randomized, parallel-group, multicenter, extension clinical trial

A 24-week, double-blind, clinical trial of rabeprazole for the prevention of recurrent peptic ulcers caused by low-dose aspirin (LDA) has been reported, but trials for longer than 24 weeks have not been reported. The aim of this study is to assess the long-term efficacy and safety of rabeprazole for preventing peptic ulcer recurrence on LDA therapy. Eligible patients had a history of peptic ulcers on long-term LDA (81 or 100 mg/day) therapy. Patients with no recurrence of peptic ulcers at the end of the 24-week double-blind phase with rabeprazole (10- or 5-mg once daily) or teprenone (50 mg three times daily) entered the extension phase. Rabeprazole doses were maintained for a maximum of 76 weeks, including the double-blind 24-week period and the extension phase period (long-term rabeprazole 10- and 5-mg groups). Teprenone was randomly switched to rabeprazole 10 or 5 mg for a maximum of 52 weeks in the extension phase (newly-initiated rabeprazole 10- and 5-mg groups). The full analysis set consisted of 151 and 150 subjects in the long-term rabeprazole 10- and 5-mg groups, respectively, and the cumulative recurrence rates of peptic ulcers were 2.2 and 3.7%, respectively. Recurrent peptic ulcers were not observed in the newly-initiated rabeprazole 10- and 5-mg groups. No bleeding ulcers were reported. No clinically significant safety findings, including cardiovascular events, emerged. The use of long-term rabeprazole 10- and 5-mg once daily prevents the recurrence of peptic ulcers in subjects on low-dose aspirin therapy, and both were well-tolerated.

Risk of bleeding in patients with cardiovascular disease on aspirin undergoing tooth extraction

Background and purpose: Aspirin is the most frequently used preventive and therapeutic drug for patients with cardiovascular diseases because of its antiplatelet property, which might lead to the risk of excessive bleeding during the surgery. The purpose of the study is to analyze if there is a need to discontinue low dose antiplatelet therapy before dental extraction. Methodology: The study samples consisted of 25 patients receiving 100 milligrams of aspirin daily and were scheduled to undergo dental extractions. Each patient acted as a control for himself, wherein an extraction was performed on a patient when aspirin was not discontinued and a second extraction after discontinuing aspirin for 72 hours prior the procedure. The bleeding time, clotting time, platelet count and INR were measured preoperatively at both the appointments and the amount of blood loss during the procedure was assessed. Results: The mean blood loss at the first appointment for the patients was 5.78 ml while it was 1.18 ml at the second appointment. The difference was statistically significant with a t – value of 3.2. However, the blood loss in patients during the first appointment was easily managed using local hemostatic measures which prevent any grave bleeding complication. Conclusion: From the observation in this study it can be stated that the low dose aspirin therapy can be continued prior to extraction procedure in the oral cavity without the fear of excessive intra-operative and post-operative bleeding. Key words: Cardiovascular Disease, Aspirin, Tooth Extraction, Blood Loss

Combined low-dose aspirin and warfarin anticoagulant therapy of postoperative atrial fibrillation following mechanical heart valve replacement.

The safety and efficacy of combined low dose aspirin and warfarin therapy in patients with atrial fibrillation after mechanical heart valve replacement were evaluated. A total of 1016 patients (620 females, mean age of 36.8±7.7 years) admitted for cardiac valve replacement and complicated with atrial fibrillation after surgery were randomly divided into study (warfarin plus 75-100 mg aspirin) or control (warfarin only) groups. International normalized ratio (INR) and prothrombin time were maintained at 1.8-2.5 and 1.5-2.0 times the normal values, respectively. Thromboembolic events and major bleedings were registered during the follow-up period. Patients were followed up for 24±9 months. The average dose of warfarin in the study and control groups was 2.91±0.83 mg and 2.88±0.76 mg, respectively (P>0.05). The incidence of overall thromboembolic events in study group was lower than that in control group (2.16% vs. 4.35%, P=0.049). No statistically significant differences were found in hemorrhage events (3.53% vs. 3.95%, P=0.722) or mortality (0.20% vs. 0.40%, P=0.559) between the two groups. Combined low dose aspirin and warfarin therapy in the patients with atrial fibrillation following mechanical heart valve replacement significantly decreased thromboembolic events as compared with warfarin therapy alone. This combined treatment was not associated with an increase in the risk of major bleeding or mortality.

ASSA14-03-38 Comparison of Urinary11-DehydrothromboxaneB2 detection and Plasma LTA Assay for evaluating aspirin response in the Aged Patients with Coronary Artery Disease

Aims Aspirin is widely used in the primary and secondary prevention of cardiovascular diseases. Nevertheless, the responses to aspirin administration vary from one patient to another, and there is a lack of efficient and platelet-specific method correlated well with clinical outcomes. The aim of our study was to make comparisons between 2 established methods of aspirin response evaluation)—measurement of urinary 11-dehydrothromboxane B2 (11dhTxB2) and plasma Light Transmission Aggregometry (LTA) assay—in aged patients with coronary artery disease (CAD), and examinethe relationship between AR and clinical outcomes. Methods A total of 145 aged patients with CAD on low-dose aspirin (100 mg/d) therapy were enrolled in this study. All patients were measuredby urinary11dhTxB2 and platelet aggregation. Aspirin response was assessed via urinary 11dhTxB2 measurement and plasma LTAassay. AspirinResistance (AR) was defined as urinary11dhTxB2 >1500 pg/mg or 0.5 mg/ml AA-induced platelet aggregation ≥ 15.07%. The Spearman correlation coefficients andkappa statistics were calculated to assess correlation and agreement between the2 tests. The measured clinical outcome was defined as the occurrence of cardiovascular events and death. Results Prevalence of aspirin non-responders was 32.1% and 13.2%, according to urinary 11dhTxB2 measurement and LTA assay, respectively. Poor correlation in the results between the 2 tests was observed (r = 0.135, p = 0.151). Besides, the correlation between the 2 methods and AR was weak (kappa = 0.113, p = 0.113). With a mean follow-up time of 12 months, the clinical outcomes occurred more frequently in AR patients based on urinary 11dhTxB2 measurement as compared with normal aspirin response patients (18% vs 2%, OR: 8.8, 95% CI: 1.18~65.4, p = 0.037). Conclusions Our research observed poor correlation and lack of agreement between the 2 tests. Urinary 11dhTxB2 measurement might be a better predictor in the risk of cardiovascular events and death as compared to LTA assay. Nevertheless, development of efficient and inexpensive platelet function tests, which should also have a good correlation with clinical outcomes was necessary.

Evaluation of aspirin use in patients with diabetes receiving care in community health.

The American Diabetes Association (ADA) recommends low-dose aspirin therapy as a primary prevention strategy in patients with type 1 or type 2 diabetes mellitus (DM) at increased cardiovascular risk. However, not all patients who are indicated are taking aspirin therapy, and it is not routinely documented in the electronic health record (EHR). To determine frequencies of appropriate aspirin use and documentation in the EHR in adult patients with DM. Adult patients with DM were randomized and contacted for participation in a telephonic survey between January and October 2013. Patients who consented were administered a standardized oral telephone survey regarding aspirin use. Patient demographics, current medications, allergies, past medical history, and pertinent laboratory values were collected. Patients were then stratified by the ADA-defined indication for aspirin. The primary outcomes were rates of appropriate aspirin use and documentation of aspirin therapy in the EHR. Investigators contacted 276 patients for inclusion. Of the 81 patients surveyed, 74% were indicated for aspirin therapy. Nearly all (92.3%) patients reporting aspirin use were indicated for aspirin therapy compared with only 57.1% of patients who did not report aspirin but were indicated (P = 0.0003). Alternatively, 96.7% of patients with aspirin use documented in their EHR were indicated for aspirin therapy compared with only 60.8% of patients who did not have aspirin use documented in the EHR but had an indication (P = 0.0002). Approximately 20% of the patients indicated for and reporting aspirin use did not have aspirin documented in their EHR. Aspirin use in patients with DM who are indicated for therapy is significantly underutilized and underdocumented.

Randomised clinical trial: prevention of recurrence of peptic ulcers by rabeprazole in patients taking low-dose aspirin.

Few studies have evaluated the effects of rabeprazole on low-dose aspirin (LDA)-induced gastroduodenal injuries. To conduct a randomised, double-blind, triple-dummy, active-controlled, multicentre trial, named the PLANETARIUM study, to assess the efficacy, dose-response relationship and safety of rabeprazole for peptic ulcer recurrence in Japanese patients on long-term LDA therapy. Eligible patients had a history of endoscopically confirmed peptic ulcers and were receiving long-term LDA (81 or 100 mg/day) therapy for cardiovascular or cerebrovascular protection. Subjects were randomly segregated into three groups receiving rabeprazole 10 mg once daily (standard dose in Japan), rabeprazole 5 mg once daily, or teprenone (geranylgeranylacetone; mucosal protective agent commercially available in Japan) 50 mg three times per day as an active control. The primary endpoint was recurrence of peptic ulcers over 24 weeks. Among 472 randomised subjects, 452 subjects (n = 151, 150, 151, respectively) constituted the full analysis set. The cumulative recurrence rates of peptic ulcers over 24 weeks in the 10- and 5-mg rabeprazole groups were 1.4% and 2.8%, respectively, both of which were significantly lower than that in the teprenone group (21.7%). The cumulative occurrence rate of bleeding ulcers over 24 weeks in the teprenone group was 4.6%, while bleeding ulcers were not observed in the 10- or 5-mg rabeprazole groups. Rabeprazole was well tolerated at both doses. Rabeprazole prevents the recurrence of peptic ulcers with no evidence of a major dose-response effect in subjects on low-dose aspirin therapy.

Aspirin reload before elective percutaneous coronary intervention: impact on serum thromboxane b2 and myocardial reperfusion indexes.

Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B2, a stable metabolite of thromboxane A2, may be implicated in post-PCI microvascular obstruction. We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B2, reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005). Aspirin loading dose before elective PCI improves myocardial reperfusion and injury indexes, suggesting a possible role of platelet thromboxane A2 in microvascular occlusion. http://www.clinicaltrials.gov. Unique identifier: NCT01374698.

Small-Bowel Mucosal Damage with Low-Dose Aspirin Therapy

Low-dose aspirin (75–325 mg per day) is associated with small-intestine damage. To assess the magnitude of this effect and associated risk factors,

Tu1055 TAK-438 Versus Lansoprazole 15 mg for Secondary Prevention of Peptic Ulcers Associated With Low-Dose Aspirin Therapy: Results of a Phase 3 Trial

Background and Aims: Gastroesophageal reflux is considered to cause sleep disturbance, while proton pump inhibitor (PPI) administration is reported to improve insomnia associated with gastroesophageal reflux disease (GERD). The majority of patients with gastroesophageal reflux are asymptomatic and a significant number with erosive esophagitis are also reported to be asymptomatic. Therefore, PPIs may improve sleep disturbance not only for symptomatic GERD patients, but also individuals without reflux symptoms if asymptomatic reflux is an important factor to cause insomnia. We examined whether PPI administration has a therapeutic effect for improving insomnia in patients without reflux symptoms in the same manner as patients with reflux symptoms. Methods: We performed a randomized multicenter doubleblind placebo-controlled trial using 176 patients with insomnia regardless of the presence of reflux symptoms. The patients were divided into those administered omeprazole (20 mg) or a placebo for 14 days. Four self-reporting questionnaires, QOLRAD-J(Japanese translation of Quality of Life in Reflux and Dyspepsia questionnaire), PSQI(Pittsburg Sleep Quality Index) , ESS (Epworth Sleepiness Scale), and a sleep diary, were used for evaluating GERDrelated quality of life and sleep disturbance. Results:We evaluated 171 patients with insomnia, of whom 69 had typical reflux symptoms. Omeprazole improved GERD-related quality of life and insomnia significantly better than the placebo in patients with reflux symptoms. On the other hand, the therapeutic effects of omeprazole and the placebo were not different in patients without reflux symptoms.(Table) Conclusion: Our results showed that PPI administration is effective only for insomnia in patients with reflux symptoms. Effects of omeprazole and placebo on reflux and sleep indices in patients with heartburn and/or acid regurgitation

Aspirin Use in Heart Failure

Background— Aspirin use in heart failure (HF) is controversial. The drug has proven benefit in comorbidities associated with HF; however, retrospective analysis of angiotensin-converting enzyme inhibitor trials and prospective comparisons with warfarin have shown increased risk of morbidity with aspirin use. This study aims to evaluate the association of low-dose aspirin with mortality and morbidity risk in a large community-based cohort. Methods and Results— This was a retrospective cohort study of patients attending an HF disease management program. Aspirin use at baseline and its association with mortality and HF hospitalization in the population was examined. Of 1476 patients (mean age, 70.4±12.4 years; 63% men), 892 (60.4%) were prescribed aspirin. Low-dose aspirin (75 mg/d) was prescribed to 828 (92.8%) patients. Median follow-up time was 2.6 (0.8–4.5) years. During the follow-up period, 464 (31.4%) patients died. In adjusted analysis, low-dose aspirin use was associated with reduced mortality risk compared with nonaspirin use (hazard ratio=0.58; 95% confidence interval, 0.46–0.74), and this was confirmed by a propensity-matched subgroup analysis. Low-dose aspirin use was associated with reduced risk of HF hospitalization compared with nonaspirin use in the total population (adjusted hazard ratio=0.70; 95% confidence interval, 0.54–0.90). In adjusted analysis, there was no difference in mortality or HF hospitalization between high-dose aspirin users (&gt;75 mg/d) and nonaspirin users. Conclusions— In this study, low-dose aspirin therapy was associated with a significant reduction in mortality and morbidity risk during long-term follow-up. These results suggest that low-dose aspirin may have a continuing role in secondary prevention in HF and underline the need for more trials of low-dose aspirin use in HF.

A Study of low-dose Aspirin on endometrial and subendometrial blood flows in ovulation induction

Objective To investigate Low-dose Aspirin Effects on Endometrial and subendometrial blood flows in ovulation induction.Metbods A prospective study on the women(254cycles)who received ovulation induction in our hospital were randomly allocated into two groups:A group (Aspirin group,136 cycles)with Low dose aspirin (50 mg/d) and clomiphene citrate(100 mg/d on cycle days 5 to 9)in ovulation induction; B group (CC group,118 cycles) only with clomiphene citrate(100 mg/d on cycle days 5 to 9).Transvaginal color Doppler ultrasound examination was performed to determine the blood flow distribution patterns,pulsatility index (PI),resistance index(RI),systolic/diastolic ratio(S/D) of endometrial and subendometrial blood flows on the day of HCG injection.Results Grades of visible blood flow of the endometrial detected by Transvaginal color Doppler ultrasound was significantly different between the two groups(P＜0.01).Aspirin group had lower PI,RT,and S/D of endometrial and subendometrial blood flows than those in the B group (P＜0.01).Conclusion Low dose aspirin therapy in ovulation induction combined with CC can promotes endometrial and subendometrial blood flows. Key words: Aspirin; Ovulation induction; Endometrial and subendometrial blood flows

Low-dose Aspirin and Comorbidities are Significantly Related to Bleeding Peptic Ulcers in Elderly Patients Compared with Nonelderly Patients in Japan

The present study was conducted using data accumulated from our earlier study of bleeding peptic ulcers, focusing on elderly patients. A total of 461 patients with bleeding peptic ulcers underwent emergency endoscopy at Saga Medical School Hospital between 1999 and 2011. Risk factors for bleeding peptic ulcers were compared between two groups: an elderly group (≥65 years old) and a nonelderly group (<65 years old). The relationship between drug use and age was examined using multiple logistic regression models. In the elderly group, the factors were compared between Period I (1999-2005) and Period II (2006-2011). The proportion of men and the incidence of Helicobacter pylori infection were lower in the elderly group than in the nonelderly group. The use of low-dose aspirin, antithrombotic drugs and corticosteroids, but not nonsteroidal anti-inflammatory drugs, was higher in the elderly group. A multiple logistic regression analysis of prescribed medications indicated that low-dose aspirin was more frequently used in the elderly group. The rate of comorbidities was higher and the hemoglobin levels were lower in the elderly group. The rates of rebleeding within one week and death within one month did not differ in the elderly group. Compared with that observed in Period I, the incidence of Helicobacter pylori infection was decreased and the rate of comorbidities was increased in Period II. This study indicates that factors related to bleeding peptic ulcers in elderly patients have shifted from Helicobacter pylori infection to comorbidities associated with low-dose aspirin, suggesting a close relationship between low-dose aspirin therapy and comorbidities in elderly patients with peptic ulcers.

Aspirin for Prevention of Subarachnoid Hemorrhage

Aspirin for Prevention of Subarachnoid Hemorrhage