Mg Of Aspirin Research Articles

Effectiveness of mixture of aspirin and ethanol regimen in the management of geographic tongue: a prospective study.

The objective was to evaluate the effectiveness of an aspirin-ethanol mixture in the management of geographic tongue. In this prospective study, an analysis of medical reports of symptomatic cases of geographic tongue managed using an aspirin-ethanol mixture was done. The treatment regimen involved dissolving 3mg of aspirin (acetylsalicylic acid) into 1ml of 70% v/v ethanol. Then a sterile gauze is soaked in the prepared mixture and is topically used to clean the tongue with gentle pressure for 2-3min. The records of 23 patients were analyzed. There were more females (19, 82.6%), and the age range of patients was 15-43 years (mean age of 23.4 years). The symptoms that the patient described included: oral discomfort, burning sensations of the tongue, pain, and loss of taste. Only 21 (91.3%) patients were asymptomatic at 3 months of follow-up. Short-term topical application of the aspirin-ethanol mixture was shown to be effective in treating symptomatic geographic tongue.

A Randomized Controlled Study Comparing the Efficacy of 75mg Versus 150mg Aspirin for the Prevention of Preeclampsia in High-Risk Pregnant Women.

Background Preeclampsia is a major factor in both maternal and fetal morbidity and mortality. The most widely investigated preeclampsia prevention medication is low dose Aspirin. However, guidelines differ considerably regarding the prophylactic dose of Aspirin for preeclampsia. Objective The objective is to compare the efficacy of 150mg versus 75mg Aspirin for the prevention of preeclampsia in pregnant women at high risk of preeclampsia. Methodology This was a parallel, open-label, randomized control trial carried over a period of one year and three months at a tertiary care center ofEasternIndia. Block randomization was done and block sizes of 2 and 4 were used to ensure balanced distributions within the study arms. Primary outcome was the development of preeclampsia and secondary outcomes were fetomaternal complications in both groups. Results The present clinical trial was conducted on 116 pregnant women with a risk factor of preeclampsia andthey were randomly assigned to receive either 150mg or 75mg of Aspirin daily beginning from 12 to 16 weeks of gestation till 36 weeks' gestation. A significantly greater number of pregnant females who received Aspirin 75mg (33.92%) developed preeclampsia in contrast to those who received Aspirin 150mg (8.77%), p=0.001, OR = 5.341, 95%CI = 1.829-15.594. There was an insignificant difference in fetomaternaloutcome among both the groups ofwomen. Conclusion Among womenwho are at high risk of developing preeclampsia, Aspirin 150 mg once a day at bedtime is more effective than Aspirin 75 mg once a day at bedtime in preventing preeclampsia with similar fetomaternal outcomes (NICU admission, IUGR, neonatal death, still birth, eclampsia, HELLP syndrome, placental abruption and pulmonary edema).

Low-dose aspirin therapy for the prevention of preeclampsia: time to reconsider our recommendations?

The American College of Obstetricians and Gynecologists recommends initiation of 81 mg of aspirin daily for women at risk of preeclampsia between 12 and 28 weeks' gestation, optimally before 16 weeks, with continuation until delivery. The World Health Organization recommends that 75 mg of aspirin should be initiated before 20 weeks of gestation for women at high risk of preeclampsia. Both the Royal College of Obstetricians and Gynaecologists and the National Institute of Health and Care Excellence quality statement on "Antenatal Assessment of Pre-eclampsia Risk" request that healthcare providers prescribe low-dose aspirin to pregnant women at increased risk of preeclampsia daily from 12 weeks of gestation. The Royal College of Obstetricians and Gynaecologists recommends 150 mg of aspirin daily, and the National Institute of Health and Care Excellence guidelines suggest risk stratification with a dosage of 75 mg for those at moderate risk of preeclampsia and 150 mg for those at high risk of preeclampsia. The International Federation of Gynecology and Obstetrics initiative on preeclampsia recommends 150 mg of aspirin to be initiated at 11 to 14+6 week's gestation and also proposes that 2 tablets of 81 mg is an acceptable alternative. Review of the available evidence suggests that both the dosage and timing of aspirin initiation is key to its effectiveness at reducing the risk of preeclampsia. Doses of >100 mg of aspirin daily initiated before 16 weeks' gestation seem to be most effective at reducing the risk of preeclampsia and thus dosages recommended by most major societies and organizations may not be effective. Randomized control trials examining 81 mg vs 162 mg of aspirin daily for the prevention of preeclampsia are required to assess the safety and efficacy of aspirin dosages available in the United States.

Bleeding during epidural analgesia: case report

BACKGROUND: Bleeding at the puncture site during neuraxial blocks is a potentially dangerous complication, and its risk is significantly increased in patients receiving antithrombotic therapy.
 CLINICAL CASE DESCRIPTION: Patient S. (aged 60 years) was admitted to the department of vascular surgery (Vladivostok). He was diagnosed with Leriches syndrome, for which he took 100 mg of aspirin and 75 mg of clopidogrel. On January 12, 2022, combined spinal-epidural anesthesia was performed, and the epidural space was punctured on the fourth attempt. However, massive bleeding was observed from the puncture site. Intraoperatively, before the great vessels were clamped, 100 units/kg of heparin (8000 units) was administered. After the operation, the epidural puncture site was revised: the sticker was soaked with hemorrhagic discharge and removed, and a new sticker was applied. On January 12, 2022, nadroparin calcium 9500 IU anti-Xa/ml 0.3 mL was given two times a day in the ICU. On the same day, intensive bleeding was noted in the area where the epidural catheter was located. This was treated locally with cold and two doses of fresh frozen plasma. On January 13, 2022, magnetic resonance imaging of the lumbar spine showed the spinal cord without displacement and compression, the puncture area had no signs of bleeding, the epidural catheter was removed, and the patient was discharged for outpatient treatment on day 7.
 CONCLUSION: To reduce bleeding risk in neuraxial blockade, the recommendations for preparing for surgery patients receiving anticoagulant and antiplatelet therapy must be followed, and the pharmacokinetics of antithrombotic drugs must be taken into account. If puncture and catheterization of the epidural space are technically difficult, manipulation should be abandoned.

Comparison of 300 mg versus 600 mg daily maintenance doses of aspirin treatment after desensitization in N-ERD: A three-year multicentre experience

Background: Aspirin treatment after desensitization (ATAD) is effective in preventing nasal polyps recurrence as well as respiratory symptoms in patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory diseases (N-ERD). However, there is no consensus on effective daily maintenance doses in ATAD. Therefore, we aimed to compare the effects of two different maintenance doses of aspirin on clinical outcomes for 1-3 years of ATAD. Methods: This was a retrospective, multicenter study that involved four tertiary centers. The maintenance doses of daily aspirin were 300 mg in one center and 600 mg in the remaining three. The data of patients who were on ATAD for 1-3 years were included. Study outcomes (nasal surgeries, sinusitis, asthma attacks, hospitalization, oral corticosteroid use, and medication uses) were assessed in a standardized way and recorded from case files. Results: The study initially included 125 subjects, 38 and 87 were receiving 300 and 600 mg daily aspirin for ATAD, respectively. Number of nasal polyp surgeries decreased after 1 -3 years compared with before ATAD in both groups (group 1, baseline: 0.44 ± 0.07 versus first year: 0.08 ± 0.05; p < 0.001 and baseline: 0.44 ± 0.07 versus 3rd year: 0.01 ± 0.01; p < 0.001; and group 2, baseline 0.42 ± 0.03 versus first year: 0.02 ± 0.02; p < 0.001 and baseline: 0.42 ± 0.03 versus 3rd year: 0.07 ± 0.03; p < 0.001). Conclusion: Given the comparable effects of 300 mg and 600 mg aspirin daily as maintenance treatment of ATAD on both asthma and sinonasal outcomes in N-ERD, our results suggest using 300 mg of aspirin daily in ATAD owing to its better safety profile.

Abstract Number ‐ 138: Complex symptomatic dissecting pseudoaneurysm with inflow zone stenosis required angioplasty before flow‐diversion‐a technical report.

Introduction 16.4 percent of patients diagnosed with fibromuscular dysplasia (FMD) are found to have internal carotid artery (ICA) dissection [1] which may lead to life threatening ICA dissecting pseudoaneurysm (ICADPA). Endovascular repair of ICADPA may be urgent when ICADPA is symptomatic, potential for rupture with no good alternatives. Tortuous anatomy with FMD and ICADS can represent a significant endovascular challenge, especially if there is an aneurysmal inflow‐zone stenosis.Objective: We present a unique case of right ICADPA with an inflow‐zone parent artery stenosis underwent angioplasty and repair with surpass evolve flow diverter (SEFD). Methods Case report and chart review. Results 49‐year‐old man history of hypertension, hyperlipidemia, and left ICADPA status post stenting/stent‐assisted coiling in 2017, who presented with right‐sided pulsatile tinnitus after a facial injury. Cerebral angiography revealed a tortuous right ICA with FMD, and presence of a right ICADPA at the skull base measuring 16×8 mm with inflow zone stenosis and a post‐stenotic dilatation. An emergency repair was performed with an informed consent under general anesthesia. In order for the SEFD to deploy properly, an angioplasty of inflow‐zone parent artery stenosis was performed with a 3×20mm Maverick balloon. Subsequently, a SEFD measuring 5×40 mm was deployed to cover the dissecting pseudoaneurysm, and a second SEFD measuring 5×20 mm was deployed covering the ICADS resulting in good apposition of SEFD and securement of ICADS.Use of a metal self‐deployable stent prior to flow diversion was not an option due to the presence of extreme tortuosity and acute angulations on the parent artery.patient was discharged home after 24 hours with 325 mg of aspirin and 75 mg of clopidogrel and good blood pressure control. 90‐days follow‐up, demonstrated good recovery with modified Rankin score of 0 with no symptoms. Conclusions ICADPA with aneurysmal inflow zone parent artery stenosis and the presence of extream tortuosity and acute angulations, may require angioplasty prior to the flow diversion for successful repair. Further studies are required.

Abstract Number ‐ 188: Rescue Stenting for Intracranial Stenosis In ELVO patients Using Neuroform Atlas Stent Through Gateway Balloon

Introduction Management of acute large vessel occlusion due to intracranial stenosis remains challenging with high complication and poor recanalization rates. Morbidity is also related to the intracranial exchange that is required for stent placement after the rescue angioplasty. We aim to present our initial experience of deployment of Neuroform Atlas stent through the lumen of a Gateway angioplasty balloon to avoid microcatheter exchange. Methods Patients were identified from prospectively collected mechanical thrombectomy stroke database from Feb 2019 to July 2021. Demographic and clinical information was collected. Primary outcomes were favorable functional outcome at hospital discharge (modified Rankin Scale (mRS) score of 0–3), and the rate of intracranial hemorrhage (ICH). Good angiographic recanalization (TICI ≥ 2b), and mortality at 30 days were other outcomes. Results We identified 5 patients treated with this approach [mean age 54 ± 14 years, all were men] who presented with large vessel occlusion of middle cerebral artery. Initial median NIHSS was 8 (range 6–16) with one patient received IV t‐PA. Patient initially underwent mechanical thrombectomy using the Solumbra technique. Due to reocclusion or impending occlusion with evidence of atherosclerotic plaque, rescue angioplasty with stent placement was performed. Patients were loaded with 650 mg of aspirin and 180 mg of ticagrelor through nasogastric tube prior. Balloon angioplasty was performed using the gateway balloon size ranging from 1.5 to 3 mm which was inflated to subnominal pressures over 1 minutes. This was followed by placing Neuroform atlas stent through the gateway balloon with size ranging from 3 to 4 mm diameter and length ranges from 21–24 mm. TICI ≥ 2b was achieved in 4 patients. Mean time from symptoms onset to revascularization was (336 ± 90) minutes. One patient had asymptomatic ICH. 2 patients had mRs 0–3 at the time of discharge and one patient was dead at 1 month Conclusions Our preliminary experience showed lower risk of guidewire perforation as well as potentially decreased operative time and early reperfusion by deploying the Neuroform stent through a compatible gateway balloon microcatheter. This should be investigated further in a large multicenter study

Aspirin protects against preeclampsia via p38MAPK signaling pathway

Purpose: To investigate the protective effect of aspirin against preeclampsia and the involvement of p38MAPK signaling pathway in the process.Methods: Sixty pregnant women who underwent antenatal care and delivery at Chancheng Central Hospital from September 2020 to September 2022 were selected and equally assigned to control group (CG) and experimental group (EG). From the 12th week of gestation, EG was administered 100 mg of aspirin and 1000 mg of calcium carbonate daily, while CG was given only 1000 mg of calcium carbonate daily. Both groups were treated up to the 35th week of gestation. Thereafter, blood samples were taken for measurement of serum levels of p38MAPK. In addition, the blood pressure of the women was measured. The incidence of preeclampsia and maternal-infant outcomes were assessed.Results: EG had a lower p38MAPK level at week 35 of pregnancy, and lower blood pressure levels at the 27th and 35th weeks of gestation, than CG (p &lt; 0.05). There were 5 cases of preeclampsia (16.7 %) in EG, and 13 cases (43.3 %) of preeclampsia in CG, with a lower incidence of preeclampsia in EG than in CG (ꭓ2 = 5.079, p &lt; 0.05). The numbers of newborns through premature delivery and cesarean section, as well as Apgar score ≤ 7 were lower in EG than in CG (p &lt; 0.05).Conclusion: Aspirin exerts a protective effect against preeclampsia through via p38MAPK signaling pathway. Therefore, aspirin treatment may be useful in reducing the incidence of preeclampsia and improving maternal-infant outcomes. However, further clinical trials are recommended prior to application in clinical practice.

Aspirin for the primary prevention of breast cancer: an unforeseen advantage

Aspirin for the primary prevention of breast cancer: an unforeseen advantage

A Study on Sensitivity of Angiogenic Factors as Predictors of Preeclampsia and Role of Aspirin in Preventing Preterm Preeclampsia

Background Preeclampsia is one of the hypertensive disorders of pregnancy causing maternal and perinatal mortality and morbidity. The global burden of Pre-eclampsia and eclampsia is 5-10. The prevalence of preeclampsia-complicating pregnancy in India is 7.8. Early prediction of preeclampsia and prophylactic use of aspirin reduces morbidity and mortality.Objectives To study the role of angiogenic factors and biophysical markers to identify women at high risk for developing preterm preeclampsia. To study the diagnostic value of angiogenic factors as predictors of preterm preeclampsia in early pregnancy. To compare the benefits of prophylactic use of 150mg of Aspirin versus 75mg of Aspirin from 11-16 weeks of gestation in reducing the incidences of preterm preeclampsia.Methods It was a two year study conducted at Rajarajeswari Medical College and Hospital. Data for the study was collected from women attending antenatal clinics at 11 weeks 0days to 13weeks 6days after taking informed consent. Screening for preeclampsia was done using biophysical and biochemical tests. Screen-positive women were grouped randomly into Group A and Group B. They were given 7mg and 150mg aspirin and maternal and fetal outcome was analysed.Results In our study 489.6 women were screened positive for preeclampsia. There were no significant differences between the 75mg aspirin group and the 150mg aspirin group with regard to demographic characteristics. Pre-eclampsia occurred in 27.2 of participants in the 75mg aspirin group compared with 4.1 in the 150 mg aspirin group. There was a significant difference in the incidence of PE p0.0293 its severity and the period of gestation at delivery in the two groups. The positive predictive value of the screening method in our study is 12.7 and the negative predictive value is 91.6.Conclusion Our study showed that screening test was beneficial in identifying high-risk cases but the study population was very less. Early screening and use of prophylactic aspirin reduce the development preterm preeclampsia. Aspirin is a safe economical and easily available drug.

Randomized, open-label, crossover trial comparing the pharmacokinetic profile of a novel oral aspirin solution and a chewed aspirin tablet.

Objectives: The primary objective of this study was to assess the pharmacokinetic profiles of acetylsalicylic acid (ASA) and salicylic acid (SA) after administration of two different formulations of aspirin under fasting and fed conditions. Materials and methods: The study was a randomized, open-label, parallel-group, 2-arm crossover study conducted at a single center. Healthy subjects were randomized to receive 300 mg of aspirin in either a 15-mL oral solution (pre-packaged vial containing powder and solvent that are combined at the time of administration) or a single solid tablet to be chewed and swallowed with 150 mL of water. Treatment visits were separated by a 10-day wash-out period. Results: At 3 minutes, ASA concentrations for the oral solution fed state and fasting state arms exceeded those for the chewed tablet (fed 299 vs. 139 ng/mL; fasting 356 vs. 204 ng/mL). Compared to the chewed tablet, the mean plasma ASA concentration was 74% greater with the oral solution under fasting conditions, and 115% greater under fed conditions. Similarly, at 3 minutes, the mean SA plasma concentration with the oral solution under fed and fasting conditions exceeded those for the chewed tablet (fed 310 vs. 160 ng/mL; fasting 330 vs. 185 ng/mL). Under fasting conditions, the mean plasma ASA AUC0-last, with the oral solutions was 168,076.8 min.ng/mL compared to 163,726.3 min.ng/mL with the chewed tablet. Under fed conditions, the mean plasma ASA AUC0-last, with the oral solutions was 179,116.7 min.ng/mL compared to 164,704.3 min.ng/mL with the chewed tablet. Conclusion: This phase 1 study showed that use of an aspirin oral solution provided more rapid exposure to higher plasma concentration levels of ASA and SA than chewing a solid tablet.

Assessment of effect of anti-platelet therapy on minor surgical procedures

Background: Antiplatelet therapy is to treat thromboembolic disorders, but it causes hemorrhages. Aspirin is the drug in regular practice. The present study was conducted to assess the effect of anti- platelet therapy on minor surgical procedures. Materials &amp; Methods: 80 patients selected for mandibular third molar extraction of both genders were randomly divided into 2 groups of 40 each. In Group I, patients on antiplatelets drugs (75 mg of aspirin/ 75 mg clopidogrel) were enrolled and in group II, patients who discontinued the drug before 5 days of extraction of mandibular third molar were enrolled. Bleeding was observed after 1 and 24 hours. Results: Group I had 24 males and 16 females and group II had 14 males and 26 females. The mean bleeding time in group I was 75.21 seconds and in group II was 75.14 seconds. The mean duration of surgery in group I was 54.2 months and in group II was 52.1 months. After 1 hour, no bleeding was seen in 38 in group I and 39 in group II and ooze in 2 in group I and 1 in group II.

Gastrointestinal Complications Associated With Non-steroidal Anti-inflammatory Drug Use Among Adults: A Retrospective, Single-Center Study.

BackgroundTraditional non-steroidal anti-inflammatory drugs (NSAIDs) are recognized to injure the upper gastrointestinal tract (GIT) mucosa. For example, gastric mucosal hemorrhages can be caused by a single dose of 650 mg of aspirin. Nearly 30% to 50% of NSAID users showed endoscopic lesions including subepithelial hemorrhages, erosions, and ulcerations. These lesions are often asymptomatic and are mostly found in the gastric antrum. With the chronic exposure, the mucosa adapts to the aggression of the NSAIDs, whereby these lesions slowly lessen or fade.AimThe aim of this study is to detect the association between NSAIDs and gastrointestinal complications among the general population in the Aseer region, Saudi Arabia.MethodologyA record-based retrospective study was conducted targeting people with GIT complications who were 20 years old and above. We reviewed patients' records from the GIT clinic in the Aseer region of Saudi Arabia. We reviewed specifically patients who had GIT complications like gastritis, abdominal pain, GIT bleeding, heartburn, nausea, vomiting, peptic ulcer, and diarrhea. Then we contacted those patients individually to fill out a questionnaire. Participants less than 18 years, those who refused to complete the questionnaire, or any patients with no history of GIT complications were excluded. An online questionnaire was sent to the patients with GIT complications. The questionnaire included participant's personal data, NSAID use, and associated GIT complications. The questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends during the period from March 2012 to May 2022.ResultsA total of 211 participants with GIT complications completed the study questionnaire. Participant ages ranged from 20-59 years with a mean age of 31.2 ± 12.9 years old. A total of 140 (66.4%) were males and 175 (82.9%) were from urban areas. A total of 156 (73.9%) were non-smokers. A total of 103 (48.8%) participants used NSAIDs. As for complications, the most reported were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications.ConclusionsThe current study revealed that nearly one out of every two participants in the Aseer region mainly used NSAIDs as tablets for pain. Regarding high utilization rates, less than half of them developed GIT complications, mainly peptic ulcers.

Low dose aspirin versus low dose aspirin plus omega 3 versus low molecular weight heparin in treatment of unexplained recurrent miscarriage

Introduction: recurrent miscarriages are the loss of 3 or more consecutive pregnancies before the 20th week of gestation. It is classified into primary and secondary. Objective: to evaluate the effectiveness of low dose aspirin vs. low dose aspirin and omega 3 vs. LMWH in treatment of unexplained recurrent miscarriage. Materials and methods: This comparative prospective research was conducted on 60 1st trimester pregnant female with a history of two or more unexplained spontaneous consecutive abortion aged from 18 to 36 years old with gestational age (5-7 weeks) and single intrauterine pregnancy. Patients were subdivided equally into 3 groups: Group A: received a daily dose of 75mg of aspirin, group B: received a daily dose of 75 mg of aspirin in addition to 300mg of omega -3 fatty acids and group C: received a daily dose of 4000 IU of enoxaparin. Results: There was an insignificant difference in pregnancy outcome among the three groups. 12 (60%) cases in group A, 15 (75%) cases in group B and 14 cases in group C completed 20 weeks of pregnancy.

P-131 Low-dose aspirin in combination with transarterial chemoembolization in treatment of unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the sixth and fourth common cancer in worldwide and Egypt. Transarterial chemoembolization (TACE) is standard treatment for unresectable HCC. Recent studies showed that TACE refractoriness impairs survival of HCC patients. Various strategies under investigation aim to improve the outcome of TACE, Aspirin demonstrated chemopreventive, antithrombotic and anti-inflammatory properties Moreover, it has been reported that aspirin may reverse apoptosis resistance in HCC cell lines. This study includes 60 patients diagnosed as unresectable HCC indicted for TACE randomized in to two arms; control arm and aspirin arm. All patients have vascular and cellular compensated liver functions; platelets count ≥ 100,000, and normal prothrombin time. We excluded patients with bleeding tendency, gastrointestinal ulcers, portal hypertension, allergy or contraindication to aspirin. Aspirin arm patients received 75 mg of aspirin daily after meal for 3 months; we assessed feasibility, toxicity of aspirin, studied treatment response and disease progression. In this study there was no significant difference between the two arms regarding baseline patients’ characteristics. Regarding compliance to aspirin, 70% of patients were regular; regarding compliance to TACE, 60% of patients were compliant to TACE in aspirin arm versus 56.7% in control arm. Most of side effects of aspirin are of grade 1 gastrointestinal side effect. According to modified RECIST criteria, better responses achieved in aspirin arm; 10% of patients in aspirin arm had complete remission versus 6.7 %in control arm and 30% had partial response in aspirin arm versus 23% in control arm, 30% of patients in aspirin arm had disease progression versus 40% in control arm; however, the difference didn’t reach statistical significant level (p=0.806). 20% of patients in control arm developed portal vein thrombosis versus only 6.7% in aspirin arm. There was an improvement in progression free survival (PFS); the median PFS was not reached for aspirin arm versus 11 months for Control arm (P=0.035). The use of adjuvant aspirin with TACE in patients with HCC is feasible and may be associated with longer PFS and a tendency of better TACE responses; however, larger sample size may yield stronger results.

Use of aspirin 100 mg / day to prevent Preeclampsia, in high risk pregnancies, in a cohort from Argentina

The objective of the present study was to analyse the use of 100 g aspirin dose as prevention method for preeclampsia in high risk pregnant patients. A retrospective cohort study was performed in high risk pregnant patients with a blood pressure protocol, and the use of 100 mg of aspirin vs. its non-use was evaluated in the incidence of PREEC. Estimations between the two groups were performed with and without variable adjustment by means of binary logistic regression models. 633 high risk pregnant patients were evaluated. The average age was 30±7 years old, and 25±8 weeks of pregnancy. 281 women (44.3 %) within this group received aspirin. The total prevalence of PREEC in our sample was 151 pregnant women (23.8 %). Pregnant patients under the aspirin treatment developed less PREEC events (19.2% vs 27.5%, p=0.019); with OR not adjusted 0.62 (IC95% 0.43-0.91 p= 0.017). The risk was similar when it was adjusted by age, preeclampsia history, diabetes mellitus and chronic high blood pressure. (OR adjusted 0.63 IC95% 0.43-0.92 p= 0.017). The use of 100 mg of aspirin a day before the 20th week of pregnancy in high risk pregnant patients decreased the risk of developing PREEC, regardless the age and risk factors.

Aspirin Colorectal Cancer Prevention in Lynch Syndrome: Recommendations in the Era of Precision Medicine.

Cancer prevention in the era of precision medicine has to consider integrated therapeutic approaches. Therapeutic cancer prevention should be offered to selected cohorts with increased cancer risk. Undoubtedly, carriers of hereditary cancer syndromes have a well-defined high cancer risk. Lynch Syndrome is one of the most frequent hereditary syndromes; it is mainly associated with colorectal cancer (CRC). Nonsteroidal anti-inflammatory drugs and, in particular, aspirin use, has been associated with reduced CRC risk in several studies, initially with contradictory results; however, longer follow-up confirmed a reduced CRC incidence and mortality. The CAPP2 study recruited 861 Lynch syndrome participants randomly assigned to 600 mg of aspirin versus placebo. Like sporadic CRCs, a significant CRC risk reduction was seen after an extended follow-up, with a median treatment time that was relatively short (2 years). The ongoing CAPP3 will address whether lower doses are equally effective. Based on pharmacology and clinical data on sporadic CRCs, the preventive effect should also be obtained with low-dose aspirin. The leading international guidelines suggest discussing with Lynch syndrome carriers the possibility of using low-dose aspirin for CRC prevention. We aim systematically promote this intervention with all Lynch syndrome carriers.

802 First United States Experience with Pipeline Flex with Shield Technology for Treatment of Intracranial Aneurysms

INTRODUCTION: Pipeline Flex with Shield technology (PED-Shield) is a third generation flow-diverter. A surface modification of the mesh with phosphorylcholine covalently bound to the metal struts aims to reduce thrombogenicity. In this study, we report the first United-States series of patients treated with the PED-Shield. METHODS: Information for the first 10 patients with intracranial aneurysms treated with PED-Shield was retrospectively collected. Patients were started on dual antiplatelet therapy (DAPT; 325 mg of aspirin and 75 mg of clopidogrel or 180 mg of ticagrelor) 7-days prior to intervention. After procedure, all patients were discharged on DAPT and planned to switch to aspirin alone at 6 months. RESULTS: Ten patients with 11 intracranial wide-necked aneurysms underwent treatment with PED-Shield between June 2021 and July 2021. The mean age of patients was 64.7 (45 - 86), and nine were female. All aneurysms were unruptured and located in the anterior-circulation. Mean maximum aneurysm diameter was 4.86mm, mean neck width was 3.05mm. Regarding morphology, all aneurysms were saccular except for one, which was fusiform. In one case, the device demonstrated insufficient distal opening, which was repaired with balloon angioplasty. There were no other technical issues or intraoperative complications. We observed no endoleak after deployment of the devices. There were two complications in the post-operative period: one patient had a groin hematoma, which was attributed to failure of the closure device and successfully managed with no clinical repercussions; one patient experienced an asymptomatic distal small intraparenchymal hematoma and trace subarachnoid hemorrhage on post-procedure non-contrast CT, which remained stable over several days. None of the patients experienced transient ischemic attacks or strokes. All patients were discharged in stable condition and unchanged functional status. CONCLUSIONS: In our initial experience with PED-Shield for the treatment of intracranial aneurysms, the device demonstrated excellent performance and no major complications. Further studies are needed to evaluate long term follow-up and safety of different antiplatelet regimens.

Comparison of the Accuracy and Completeness of Records of Serious Vascular Events in Routinely Collected Data vs Clinical Trial–Adjudicated Direct Follow-up Data in the UK

Routinely collected data could substantially decrease the cost of conducting trials. To assess the accuracy and completeness of UK routine data for ascertaining serious vascular events (SVEs) compared with adjudicated follow-up data. This was a secondary analysis of a randomized clinical trial. From June 24, 2005, to July 28, 2011, the ASCEND (A Study of Cardiovascular Events in Diabetes) primary prevention trial used mail-based methods to randomize people with diabetes without evidence of atherosclerotic vascular disease using a 2 × 2 factorial design to aspirin and/or ω-fatty acids vs matching placebo in the UK. Direct participant mail-based follow-up was the main source of outcome data, with more than 90% of the primary outcome events undergoing adjudication. Follow-up was completed on July 31, 2017. In parallel, more than 99% of participants were linked to routinely collected hospital admission and death registry data (ie, routine data), enabling post hoc randomized comparisons of different sources of outcome data (conducted from September 1, 2018, to October 1, 2021). Random allocation to 100 mg of aspirin once daily vs matching placebo and separately to 1 g of ω-3 fatty acids once daily vs placebo. The primary outcome consisted of SVEs (a composite of nonfatal myocardial infarction, ischemic stroke, transient ischemic attack [TIA], or vascular death, excluding hemorrhagic stroke). A total of 15 480 participants were randomized (mean [SD] age, 63 [9] years; 9684 [62.6%] men) and followed up for a mean (SD) of 7.4 (1.8) years. For SVEs, agreement between adjudicated direct follow-up and routine data sources was strong (1401 vs 1127 events; κ = 0.78 [95% CI, 0.76-0.80]; sensitivity, 72.0% [95% CI, 69.7%-74.4%]; specificity, 99.2% [95% CI, 99.0%-99.3%]), and sensitivity improved for SVEs excluding transient ischemic attack (1129 vs 1026 events; sensitivity, 80.6% [95% CI, 78.3%-82.9%]). Rate ratios for the aspirin-randomized comparison for adjudicated direct follow-up vs follow-up solely through routine data alone were 0.88 (95% CI, 0.79-0.97) vs 0.91 (95% CI, 0.81-1.02) for the primary outcome and 0.92 (95% CI, 0.82-1.03) vs 0.91 (95% CI, 0.80-1.02) for SVEs excluding TIA. Results were similar for the ω-3 fatty acid comparison, and adjudication did not seem to markedly change rate ratios. Post hoc analyses of the ASCEND trial suggest that routinely collected hospital admission and death registry data in the UK could be used as the sole method of follow-up for myocardial infarction, ischemic stroke resulting in hospitalization, vascular death, and arterial revascularization in primary prevention cardiovascular trials, without the need for verification by clinical adjudication.

Aspirin nonsensitivity in patients with vascular disease: Assessment by light transmission aggregometry (aspirin nonsensitivity in vascular patients)

BackgroundAspirin is a key antiplatelet therapy for the prevention of thrombotic events in patients with cardiovascular disease. Studies suggest that ≈20% of patients with cardiac disease suffer from aspirin nonsensitivity, a phenomenon characterized by the inability of 81 mg aspirin to inhibit platelet aggregation and/or prevent adverse cardiovascular events. ObjectivesTo investigate aspirin nonsensitivity in patients with vascular disease and assess the consequences of aspirin nonsensitivity. MethodsOne hundred fifty patients presenting to St. Michael’s Hospital’s outpatient clinics with evidence of vascular disease (peripheral arterial disease or carotid artery stenosis) and a previous prescription of 81 mg of aspirin were recruited in this study. Light transmission aggregometry with arachidonic acid induction was used to determine sensitivity to aspirin. Patients with a maximum aggregation ≥20% in response to arachidonic acid were considered aspirin nonsensitive, as per previous studies. ResultsOf the 150 patients recruited, 36 patients (24%) were nonsensitive to 81 mg of aspirin. Of these 36 nonsensitive patients, 30 patients provided a urine sample for urine salicyluric acid analysis (a major metabolite of aspirin). Urine analysis demonstrated that 14 patients were compliant and 16 were noncompliant with their aspirin therapy. Major adverse cardiovascular events and major adverse limb events were significantly higher in the nonsensitive patients compared to sensitive patients (hazard ratio, 3.68; P< 0.001). ConclusionThese data highlight the high prevalence of aspirin nonsensitivity and noncompliance in patients with vascular disease and emphasizes the urgent need for improved medical management options for this patient population.