Prior Aspirin Use Research Articles

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation

Abstract Background To the best of our knowledge there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes. Aim To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of non-ST-segment elevation acute coronary syndromes patients. Methods A prospective cohort study was conducted, including patients with non-ST-segment elevation acute coronary syndromes admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26. Results 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR > 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average ACR among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p > 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with ACR of 0 to 4 mg/gr, tercile 2: ACR from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p < 0.0001). Conclusion Single spot urine ACR at admission is a strong predictor of 12-year follow-up mortality in an unselected cohort of patients with non-ST-segment elevation acute coronary syndromes.Baselines characteristics of cohortsMultivariable COX regression analysis

Impact of prior aspirin use on left ventricular function in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: An echocardiographic evaluation.

Previous studies have investigated the potential influence of prior aspirin use on cardiac function in patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). However, the results from these studies have been conflicting. This study aimed to investigate whether prior aspirin use affects left ventricular (LV) function in these patients using echocardiography. The study included 260 consecutive STEMI patients, who were divided into two groups based on the presence or absence of prior aspirin use. Echocardiographic parameters, such as maximal left atrial (LA) size, LV ejection fraction (LVEF), early diastolic velocity (e'), E/A ratio, and E/e' ratio, were assessed within 72 hours of admission. Aspirin users had an older age compared to non-users, as well as lower body mass index and renal function. They also had a greater history of hypertension and were more likely to be taking statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and calcium channel blockers. There were no significant differences in LVEF, maximal LA size, E/A ratio, E/e' ratio, and deceleration time between aspirin users and non-users. e' wave was marginally lower in aspirin users (P=0.054). After controlling for confounding variables, the previous use of aspirin did not show a significant impact. Prior aspirin use in STEMI patients does not have a significant impact on LV echocardiographic parameters. Our conclusions remained consistent even after adjusting for potential confounders.

Atherosclerosis as a Risk Factor of Inflammatory Bowel Disease: A Population-Based Case-Control Study.

Data suggest atherosclerotic-related inflammation may play a role in the pathogenesis of inflammatory bowel disease (IBD), but large-scale studies are missing. In this nationwide case-control study, we used the Swedish Patient Register and the Epidemiology Strengthened by histoPathology Reports in Sweden cohort to identify adult cases of incident IBD between 2002 and 2021, with each case matched to up to 10 general population controls. We used conditional logistic regression to calculate odds ratios (OR) for exposure to an atherosclerotic-related condition (myocardial infarction, thromboembolic stroke, or atherosclerosis itself) before being diagnosed with IBD. There were a total of 56,212 individuals with IBD and 531,014 controls. Of them, 2,334 (4.2%) cases and 18,222 (3.4%) controls had a prior diagnosis of an atherosclerotic-related condition, corresponding to an OR of 1.30 (95% confidence interval [CI] 1.24-1.37). Results were statistically significant for both Crohn's disease (OR 1.37, 95% CI 1.26-1.48) and ulcerative colitis (OR 1.27, 95% CI 1.20-1.35) and for individuals who developed IBD at 40-59 years of age and 60 years or older. In addition, associations persisted when adjusting for underlying comorbidities, including the presence of immune-mediated diseases and prior aspirin and/or statin use. The highest odds of an atherosclerotic-related condition were seen in the 6-12 months before IBD diagnosis, though odds were increased even ≥5 years before. A higher magnitude of odds was also observed when having 2 or more atherosclerotic-related conditions when compared with having only 1 condition. A history of an atherosclerotic-related condition is associated with increased odds of developing IBD, particularly among older adults. Future studies should investigate whether drugs targeting atherosclerotic-related inflammation may prevent IBD in higher-risk individuals.

Estimating burden of cardiovascular disease among survivors of breast, colorectal, lung, and prostate cancer in the detroit research on cancer survivors (ROCS) cohort.

12082 Background: With new advances in cancer treatment, cancer-specific mortality has decreased by 31% over the past 3 decades. The growing number of cancer survivors has led to increased risk of other chronic conditions including cardiovascular disease (CVD), which has become an important competing cause of mortality. This study evaluates the incidence of CVD, including heart failure (HF), myocardial infarction (MI), coronary artery disease (CAD), atrial fibrillation (AF) and stroke after cancer in the Detroit ROCS cohort. Methods: ROCS is an African American cancer survivorship cohort that enrolled participants residing in the tri-county Detroit Metropolitan area. This study included survivors of breast, colorectal, lung, and prostate cancer who provided socio-demographic and clinic information on self-administered questionnaires. We calculated incidence as percentages and rates per 1,000 person-years of HF, MI, CAD, AF, and stroke after cancer. Multivariate logistic regression analysis was used to evaluate the relationship between socio-demographic and clinical predictors of CVD by using factors with p-value < 0.1. Results: After excluding patients with pre-existing CVD or lack of data on comorbidities, the study cohort consisted of 2,865 participants. The mean (SD) age at cancer diagnosis was 60.3 (9.4) years with median follow up of 3.0 (1.0-9.3) years. The incidence rate for any CVD was 23.3 per 1,000 person-years. In the study sample, stroke was the leading CVD, followed by HF, AF, CAD and MI. Lung cancer survivors had the highest incidence of CVD followed by prostate, breast, and colorectal cancer. Age at cancer diagnosis, household income, insurance, aspirin, smoking, body mass index, hypertension, diabetes, and high cholesterol were included in the final model. In the multivariate analysis, decreased household income [OR 1.26 (95% CI 1.05-1.52)], prior aspirin use [OR 1.83 (95% CI 1.34-2.49)], and history of hypertension [OR 1.71 (95% CI 1.20-2.44)] were associated with higher odds of CVD. Conclusions: CVD is a relatively common outcome within years after cancer diagnosis in an African American survivorship cohort. Intervention should focus on the possible impact of socioeconomic variables and control of hypertension in reducing the risk of CVD after cancer. [Table: see text]

Bleeding and thrombotic events in patients with colorectal cancer treated with bevacizumab and receiving novel oral anticoagulants and antiplatelet medications.

104 Background: Bevacizumab is a humanized monoclonal VEGF antibody given in combination with fluorouracil-based chemotherapy for metastatic colorectal cancer (mCRC). Many patients with mCRC also have cardiovascular comorbidities requiring anticoagulation or antiplatelet therapy. The bleeding and thrombotic event rates in the setting of concurrent novel oral anticoagulants (NOACs) and bevacizumab treatment in patients with mCRC remain unclear. Methods: 462 patients with mCRC at Barnes-Jewish Hospital were identified between December 1, 2016 and December 1, 2021 and screened for concurrent treatment with bevacizumab and anticoagulant or antiplatelet therapy. Demographic and clinical information was extracted by electronic chart review. Results: 21 patients were identified who received bevacizumab and either apixaban or rivaroxaban for mCRC treatment. Aspirin was prescribed in some of these patients within 3 years of starting apixaban or rivaroxaban. Of the 13 patients who had no history of aspirin prescription, 9 were given apixaban, and 4 were given rivaroxaban while on bevacizumab. 44.4% of the patients who received apixaban experienced bleeding. All these events were epistaxis, and only 25% of the cases resulted in any treatment discontinuation. 75% of the patients who received rivaroxaban experienced bleeding events, which 33.3% of the time resulted in discontinuation of either rivaroxaban or bevacizumab. We also looked at 8 patients who had received aspirin in the last three years: 7 patients were on apixaban, and one was on rivaroxaban while on concomitant aspirin and bevacizumab. 28.6% of the patients who received apixaban with bevacizumab and aspirin experienced an adverse bleeding event that resulted in some form of treatment discontinuation. Meanwhile, the patient who received rivaroxaban with bevacizumab and aspirin experienced a bleeding event that resulted in discontinuation of a medication. No patient experienced any adverse thrombotic events. Conclusions: Patients with mCRC treated with bevacizumab and apixaban with no history of prior aspirin use within three years have a relatively low risk of developing bleeding events that warrant treatment discontinuation. The addition of NOAC to bevacizumab therapy does not appear to increase the risk of adverse thrombotic events.

Single spot albumin to creatinine ratio as an independent predictor of 12 years follow-up mortality in acute coronary syndromes without ST-segment elevation.

Background: Up to date there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes (NSTE-ACS). Aim: To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of NSTE-ACS patients. Methods: A prospective cohort study was conducted, including patients with NSTE- ACS admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26. Results: 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR > 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average IAC among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with IAC of 0 to 4 mg/gr, tercile 2: IAC from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p 0.0001). Conclusion: Single spot urine ACR at admission is a strong predictor of 12-year follow- up mortality in an unselected cohort of patients with NSTE-ACS.

Factors affecting self-reported bleeding acceptance in acute ischemic stroke survivors on various types of antithrombotic therapy

ObjectivesPrior ischemic cerebrovascular event and younger age have been shown to increase bleeding acceptance among anticoagulated outpatients with atrial fibrillation (AF). We sought to determine factors affecting bleeding acceptance in acute ischemic stroke (AIS) survivors on various types of antithrombotic therapy. Materials and MethodsWe enrolled 173 consecutive patients hospitalized for AIS (aged 68.2±11.7 years, 54.9% male), including 54 (31.2%) with AF, who had favorable functional outcome. On discharge, the Bleeding ratio, defined as the declared maximum number of major bleedings that a patient is willing to accept to prevent one major stroke, was evaluated. We assessed the predicted bleeding risk in non-cardioembolic and cardioembolic stroke survivors using S2TOP-BLEED and HAS-BLED scores, respectively. ResultsPatients with the low Bleeding ratio, defined as 5 (median) or less accepted bleeds (n=92; 53.2%), were older and more likely to receive thrombolysis and/or thrombectomy, with no impact of previous stroke. Prior major bleed (odds ratio [OR] 4.67; 95% confidence interval [CI] 0.92-23.72), AF with use of oral anticoagulants (OR 2.35, 95% CI 1.12-4.93), reperfusion treatment (OR 1.95, 95% CI 1.02-3.76), and hospitalization ≤10 days (OR 4.56; 95% CI 1.50-13.87) were associated with the low Bleeding Ratio. Prior use of anticoagulants or aspirin as well as HAS-BLED and S2TOP-BLEED scores did not affect the bleeding acceptance. ConclusionsLower bleeding acceptance declared on discharge by AIS survivors is determined by prior bleeding, anticoagulation in AF, reperfusion treatment, and duration of hospitalization, which might affect medication adherence. The results might help optimize post-discharge management and educational efforts in patients on antithrombotic therapy.

Abstract 15192: Neighborhood Social Vulnerability Predicts Cardiovascular Disease Outcomes Through Pro-Inflammatory Risk Factors

Introduction: Emerging evidence suggests that neighborhood adverse characteristics are linked to nationwide disparities in cardiovascular disease (CVD) incidence and mortality. However, it is unclear if this association is linked to disease progression and outcomes in people with established CVD. Hypothesis: We hypothesized that in patients with CVD, neighborhood social adversity, measured as social vulnerability index (SVI) predicts incident cardiovascular events at least partly through pro-inflammatory. Methods: A total of 4150 participants enrolled in the Emory Cardiovascular Biobank, residential addresses were geocoded according to the census tract and SVI was determined using the Center for Disease Control data. Serum hs-C-reactive protein (hsCRP) levels were measured during enrollment and participants were followed up for incident myocardial infarction (MI) and cardiovascular death. Subdistribution hazard models were used to investigate the association between SVI and the study endpoint. A mediation analysis was performed to evaluate whether hsCRP levels underly this association. Results: Mean age was 63 years, 24% Black, and 64% were women. During a median 5 year follow-up, there were 904 (22%) adverse events. SVI and hsCRP were correlated (r=0.12, P<0.001). After adjustment for age, race, sex,hypertension, diabetes mellitus, body mass index, prior MI, prior heart failure, renal function, smoking, statin and aspirin use, participants in the highest SVI quartile (most socially vulnerable), had a 31% (95%CI, 4%,64%) higher risk of CV death/MI compared to those in the lowest quartile. The risk was attenuated and became insignificant after adjusting for the hsCRP 23% (CI -3%, 54%). Serum hsCRP levels mediated 61% of the association between SVI and adverse events. Conclusions: Neighborhood social vulnerability is an independent risk factor for adverse outcomes in CVD, that is at least in part mediated through increased systemic inflammation. Neighborhood social vulnerability may explain some of the residual risk observed in patients with CVD.

Does prior use of antiplatelet therapy modify the effect of dual antiplatelet therapy in transient ischaemic attack/minor ischaemic stroke: A systematic review and meta-analysis.

Background and purposeThe purpose was to determine whether prior use of antiplatelet therapy modifies the effect of dual antiplatelet therapy in patients with acute minor ischaemic stroke or transient ischaemic attack.MethodsA systematic review and meta‐analysis of randomized controlled trials was performed comparing dual antiplatelet therapy to aspirin that reported subgroup analysis by prior antiplatelet use, adhering to the Cochrane Collaboration Guidelines. A fixed‐effects meta‐analysis was used to estimate a pooled treatment effect overall in subgroups with prior aspirin therapy and without prior aspirin therapy. Difference in treatment effect was assessed by testing p for interaction. The primary outcome measure was recurrent vascular events.ResultsThree eligible randomized controlled trials were identified, including 4831 participants with pre‐existing antiplatelet use and 16,236 participants without pre‐existing aspirin use. Recurrent vascular events occurred in 7.2% (95% confidence interval [CI] 4.3–10) of those without pre‐existing aspirin use versus 7.3% (95% CI 4.1–10) of those receiving prior aspirin therapy. Effect of dual antiplatelet therapy on the primary outcome measure was consistent in participants with no prior aspirin use (odds ratio 0.75, 95% CI 0.66–0.84) compared to those taking aspirin before randomization (odds ratio 0.79, 95% CI 0.63–0.998) (p interaction = 0.66). The number needed to treat in the aspirin‐naïve group was 55 (95% CI 37‐107) compared to 66 (95% CI 32 to –746) in those on prior aspirin therapy.ConclusionsIt was found that the effectiveness of dual antiplatelet therapy in patients with minor ischaemic stroke or high risk transient ischaemic attack does not significantly differ in patients with prior aspirin exposure; therefore there should be no influence on the decision to use dual antiplatelet therapy.

The impact of vitamin and mineral supplements usage prior to COVID-19 infection on disease severity and hospitalization.

The COVID-19 pandemic has caused a global public health emergency. Nutritional status is suggested to be related to the severity of COVID-19 infection. Herein, we aimed to explore the impact of using vitamin and mineral supplements prior to COVID-19 infection on disease severity and hospitalization. In addition, the prior use of aspirin as an anticoagulant on the disease severity was investigated. A cross-sectional, self-administered survey was conducted between March and July 2021. Recovered COVID-19 individuals (age ≥ 18 years, n = 2148) were recruited in the study. A multivariate logistic regression was used to evaluate the associations of supplements and aspirin use with COVID-19 disease severity and hospitalization status. Among the participants, 12.1% reported symptoms consistent with severe COVID-19, and 10.2% were hospitalized due to COVID-19. After adjustment for confounding variables (age, gender, BMI, cigarette smoking status, and the number of comorbidities), the multivariate logistic regression model showed that the consumption of vitamin D supplements prior to COVID-19 infection was associated with a significant decrease in disease severity (OR = 0.68, 95% CI 0.50-0.92; p = 0.01), and a lower risk of hospitalization (OR = 0.64, 95% CI 0.45-0.89; p = 0.01). On the other hand, there were no significant differences in the frequencies of severe illness and hospitalizations with the consumption of vitamin A, folic acid, vitamin B12, vitamin B complex, vitamin C, zinc, iron, selenium, calcium, magnesium, omega 3, and aspirin before COVID-19 infection. Among the investigated nutrients, the use of vitamin D prior to COVID-19 infection was associated with reduced disease severity and hospitalization. However, more studies are required to confirm this finding.

Previous psychiatric disorders and antipsychotic drugs in COVID-19 patients: early findings on possible worse outcome

Abstract Background There are a range of traditional risk factors for COVID-19, but it is not well established if there are also psychiatric related risk factors. These factors could increase angiotensin-converting enzyme 2 expression and potentiate COVID-19 cell entry. Purpose We aimed to assess if psychiatric disorders and antipsychotic treatments represent risk factors for COVID-19 worst outcomes. Methods We describe the demographics, symptoms, therapeutic management, and survival outcomes of COVID-19 in the population who were admitted in a single academic hospital in Northern Italy between March 1 and June 30, 2020. Patients were determined to have COVID-19 if they had a positive SARS-CoV-19 swab. We used logistic regression analyses to control for confounding by concomitant risk factors for COVID-19 and for therapeutic management of comorbidities including psychiatric disorders and antipsychotic related drugs. Results Among 609 patients, in-hospital death occurred in 120 (19.7%). A psychiatric disorder in the previous years was overrepresented (p<0.0001) in non-survivors (35.5%) in comparison with survivors (22.1%). Age and a history of hypertension were as well, established (p<0.005) risk factors for COVID-19 adverse outcomes: 80.6±11.4 vs 68±17.4 years and 70% vs 52% of people with hypertension in non-survivors vs survivors. Various pre-existing conditions were also associated (p<0.001) with increased risk of death, such as stroke or transient ischemic attacks, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) (20% vs 8%, 35% vs 17%, and 24% vs 10%, respectively). We did not observe that prior use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers were more prevalent in non-survivors compared with survivors. On the opposite, prior use of aspirin, P2Y receptor antagonists, and antipsychotic drugs was more common (p<0.001) in non-survivors compared with their counterparts (36% vs 21%, 12% vs 5%, and 28% vs 10%, respectively). After multivariable adjustment, use of antipsychotic drugs was associated with higher risks of in-hospital death (OR: 2.27; 95% CI, 1.17–4.4). Other independent predictors of death were older age (OR: 2.8; 95% CI, 1.69–4.63), CKD (OR: 2.2; 95% CI, 1.21–4.03) and COPD (OR: 2.04; 95% CI, 1.22–3.42). Conclusions Antipsychotic drugs might be an independent risk factor for COVID-19 adverse outcomes. Although preliminary, our findings have implications for clinical services as they provide crucial information for understanding who is at greatest risk for COVID-19. Funding Acknowledgement Type of funding sources: None.

Impact of Antecedent Aspirin Use on Infarct Size, Bleeding and Composite Endpoint in Patients with de Novo Acute Myocardial Infarction.

BackgroundThe study aimed to evaluate the impact of antecedent aspirin use on infarct size, bleeding and composite endpoint in patients with de novo acute myocardial infarction.Patients and MethodsA total of 562 consecutive patients with de novo acute myocardial infarction were included in this prospective cohort study. Patients were assigned into two groups based on presence (n=212) and absence (n=350) of prior aspirin use. Primary endpoint was myocardial infarct size, as estimated by troponin I peak. In-hospital mortality, bleeding and composite clinical endpoint including cardiogenic shock, stroke, in-hospital mortality and major bleeding were also evaluated.ResultsAlthough GRACE and CRUSADE scores were higher, troponin I peak was lower in prior aspirin users. This result was maintained after adjustment for baseline ischemic risk profile and other major confounders including MI type and location. Despite high CRUSADE score, there was no increase in major and minor bleeding. Minimal bleeding was higher in antecedent aspirin users. When it was adjusted for the CRUSADE score, a similar risk was reported.ConclusionPatients with de novo acute myocardial infarction using aspirin for primary prevention have an unexpectedly smaller infarct size and similar bleeding rates.

Platelet Reactivity Testing for Aspirin Patients Who Sustain Traumatic Intracranial Hemorrhage

BackgroundPatients who take aspirin and sustain traumatic intracranial hemorrhage (tICH) are often transfused platelets in an effort to prevent bleeding progression. The efficacy of platelet transfusion is questionable, however, and some medical societies recommend that platelet reactivity testing (PRT) should guide transfusion decisions. The study hypothesis was that utilization of PRT to guide platelet transfusion for tICH patients suspected of taking aspirin would safely identify patients who did not require platelet transfusion. MethodsThis was a retrospective study of patients with blunt tICH who received PRT for known or suspected aspirin use between June 2014 and December 2017 at a level I trauma center. Chart abstraction was conducted to determine home aspirin status, and PRT values were used to classify patients as therapeutic or nontherapeutic on aspirin. Differences were assessed with Kruskal-Wallis and chi-square tests. Results157 patients met study inclusion criteria, and 118 (75%) patients had documented prior aspirin use. PRT results were available approximately 1.7 h (IQR: 0.9, 3.2) after arrival. Upon initial PRT, 70% of patients were considered inhibited and 88% of those patients had aspirin documented as a home medication. Conversely, 18% of patients with home aspirin use had normal platelet reactivity. Clinically significant worsening of the tICH did not significantly differ when comparing those who received platelet transfusion with those who did not (8% versus 7%, P = 0.87). ConclusionsPlatelet reactivity testing can detect platelet inhibition related to aspirin and should guide transfusion decisions for head injured patients in the initial hours after trauma.

Concomitant Aspirin and Anticoagulation Is Associated With Increased Risk for Major Bleeding in Surgical Patients Requiring Postoperative Intensive Care.

Critically ill surgical patients may receive concomitant aspirin and therapeutic anticoagulation postoperatively, yet the safety of this practice remains unknown. We evaluated the risk of major bleeding with concomitant therapy compared with anticoagulation alone. Observational cohort study. Inverse probability of treatment weighting was used to assess the association between concomitant therapy and a primary outcome of major bleeding. Postoperative ICUs at an academic medical center. Adults (≥ 18 yr old) receiving anticoagulation during postoperative ICU admission between 2007 and 2016. None. Nine thousand five hundred eighteen anticoagulated patients were included, including 3,237 (34%) receiving aspirin. A total of 1,874 unique patients (19.7%) experienced a major bleeding event. In inverse probability of treatment weighting analyses, concomitant therapy was associated with increased odds for major bleeding (odds ratio, 1.20; 95% CI, 1.05-1.36; p = 0.006) compared with anticoagulation alone. An interaction test suggested a differential relationship between aspirin use and major bleeding based on aspirin use in the 7 days prior to anticoagulation, such that a strong association between aspirin and major bleeding was observed for recent initiators of aspirin (1.40; 1.13-1.72;p = 0.002) but not for those continuing prior aspirin use. Aspirin use prior to anticoagulation did not modify the relationship between concomitant therapy and new myocardial infarction or stroke (i.e., rates were not increased with aspirin discontinuation prior to anticoagulation). Concomitant aspirin and anticoagulation in critically ill surgical patients was associated with an increased rate of major bleeding. Future investigations are warranted to further define optimal management of antiplatelet therapy during anticoagulation in surgical patients.

Abstract WP114: Effect of Prestroke Aspirin on Infarct Volume

Objective: To investigate if prestroke aspirin use affects infarct volume, generally and by subtype. Background: Prestroke aspirin use may reduce initial stroke severity and improve functional outcome at discharge, especially in the large artery atherosclerosis (LAA) stroke. We investigated whether prestroke aspirin use is associated with infarct volume and the effect of prestroke aspirin on infarct volume is different between LAA versus non-LAA strokes. Methods: A total of 4427 patients were included. The association between infarct volume on DWI and prior aspirin use was assessed by multiple linear regression analysis. To adjust a significant imbalance between aspirin users vs. non-aspirin users, the augmented inverse-probability weighting (AIPW) and propensity score matching were used. Results: Mean age was 67.7(SD 12.4) years and 58.7% were male. 19.6% (n=869) took aspirin before stroke. Prestroke aspirin had an inverse relation with log-infarct volume (P = 0.007) and the effect was significantly modified by LAA versus non-LAA strokes (P for interaction = 0.02). In LAA stroke (n=2336), prestroke aspirin use was independently associated with log-infarct volume (standardized beta = -0.047; P = 0.032). In non-LAA stroke (n=2091), prestroke aspirin was not associated with infarct volume (P = 0.27). Using AIPW and propensity score matching, the mean difference of log-infarct volume between prestroke aspirin user versus non-aspirin uses was -0.28 (95% CI -0.52 to -0.04, P = 0.009) and -0.39 (95% CI -0.67 to -0.11, P = 0.02) in LAA strokes. In non-LAA strokes, AIPW and propensity score matching showed that prestroke aspirin use was not associated with infarct volume (P = 0.27 and P = 0.85, respectively). Conclusions: Our results showed that prestroke aspirin use is negatively associated with initial infarct volume on DWI in LAA strokes but not in non-LAA strokes.

Clinical Determinants of Myocardial Injury, Detectable and Serial Troponin Levels among Patients with Hypertensive Crisis.

IntroductionThere is a high prevalence of hypertensive crisis with myocardial injury, as evidenced by elevation in cardiac troponin levels. The risk factors predisposing patients to developing a myocardial injury, detectable troponin, and increase in serial troponin in this population are not known.MethodsA retrospective study was designed to include all patients, presenting to the emergency room, diagnosed with hypertensive crisis, using International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes between 2016-2018 (n=467). Logistic regression was used to determine the important predictors of myocardial injury evidenced by troponin elevation >99th percentile of upper reference level (URL), detectable troponin (> 0.015 ng/ml), and increase in serial troponin levels.ResultsThe 99th percentile of the initial troponin level among all patients was 0.433 ng/ml. A total of 15% had a myocardial injury, and the significant risk factors associated with it were body mass index (BMI) < 30 kg/m2 (odds ratio [OR] 0.50, confidence interval [CI] 0.28-0.89), congestive heart failure (CHF; OR 4.28, CI 2.21-8.25) and prior use of aspirin (OR 1.98, CI 1.08-3.63). About 35% had detectable troponin, and BMI < 30 kg/m2 (OR 0.62, CI 0.40-0.97), CHF (OR 3.49, CI 2.06-5.9), elevated creatinine (OR 1.17, CI 1.02-1.34) and age <61 years (OR 0.59, CI 0.38-0.94) were associated with it. The factors associated with an increase in serial troponin were BMI < 30 Kg/m2 (OR 0.56, CI 0.36-0.87), CHF (OR 1.78, CI 1.06-3.0), coronary artery disease (CAD; OR 2.08, CI 1.28-3.36) and non-Caucasian race (OR 0.52, CI 0.29-0.93).ConclusionAbout one-third of patients with the hypertensive crisis have detectable troponin. Still, among these, less than half have troponin levels >99th percentile URL, and the majority of these patients have minimal changes in serial troponin. Low BMI was associated with higher initial and serial troponin levels, and this obesity paradox was stronger among females and older patients.

Aspirin and nonsteroidal anti-inflammatory drug use and keratinocyte cancers: a large population-based cohort study of skin cancer in Australia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been postulated as chemopreventive agents for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), but findings from observational studies have been inconsistent, and clinical trial data are scant. To examine the association between aspirin and NSAID (nonaspirin) use and the risk of BCC and SCC in a large cohort specifically designed for skin cancer outcomes. We used data from the QSkin Study, a prospective cohort of 43764 residents of Queensland, Australia (34630 were included in this study and 23581 were used in our primary analyses). We used Cox proportional hazards models to estimate the hazard ratios (HRs) between self-reported aspirin and NSAID use 1 year prior to study baseline and the first histologically confirmed BCC or SCC for high-risk (history of skin cancer excisions or more than five actinic lesions treated) and average-to-low-risk participants (no history of skin cancer excision and at most five actinic lesions treated). After a median of 3 years of follow-up, 3421 participants developed BCC and 1470 SCC (2288 BCC and 932 SCC with complete covariate information). Among the high-risk group (1826 BCC and 796 SCC), compared with never use, frequent (at least weekly) NSAID use was associated with reduced risk of BCC (HR 0·84, 95% confidence interval 0·71-0.99) but not SCC. Aspirin use was associated with reduced risk of SCC (HR 0·77, 95% confidence interval 0·64-0·93) only among infrequent (less than weekly) users and was not associated with BCC. We observed no association between NSAID or aspirin use and the risk of BCC or SCC among average-to-low-risk participants. While some weakly inverse associations were observed between prior use of aspirin or NSAIDs and skin cancer, the inconsistent patterns of associations do not provide convincing evidence that these medications reduce subsequent skin cancer risk. Further data on doses, duration and long-term follow-up may help us to comprehend the cumulative dose effect.

Statins and the risk of bleeding in patients taking dabigatran

Dabigatran etexilate is a direct thrombin inhibitor that clinicians increasingly prescribe to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). Clinicians also commonly prescribe statins for primary and secondary prevention of cardiovascular diseases. Little is known about the bleeding risk in patients taking a statin and dabigatran together. The aim of this study was to evaluate the safety and persistence of dabigatran after co-medication with statins. We performed a prospective, multicenter registry study of stroke patients with NVAF who initiated dabigatran therapy within 3months after a clinically evident ischemic cerebrovascular event between 2013 and 2017. The main outcome measure was symptomatic bleeding after 90, 180, and 360days. In total, 652 patients (336 statin users, 316 non-users) were followed for 1year after dabigatran therapy. Cox multivariate analysis demonstrated that male sex, prior use of aspirin, and concurrent use of an antiarrhythmic drug were associated with a higher risk of bleeding at 360days. After adjusting time-dependent covariates, statin users had a significantly lower bleeding risk (adjusted hazard ratio: 0.11, P<0.001) than non-users. Kaplan-Meier analysis indicated that patients prescribed with statins had a higher rate of bleeding-free survival (P=0.028). For secondary prevention of stroke in patients with NVAF who are taking dabigatran etexilate, co-prescription with a statin was associated with a lower risk of bleeding complications. Future research is needed to determine the pharmacological mechanism underlying this effect.

Uptake of Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation in a Single Clinical Commissioning Group in England Without Restrictions to Their Use.

In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation has been slow and varied across different Clinical Commissioning Groups (CCGs). This study aimed to profile the prescribing of oral anticoagulants for stroke prevention in patients with atrial fibrillation over 3years in a CCG without restrictions to DOACs use to understand more about organisational and/or individual barriers to the early uptake of DOACs. Data were collected from nine general practices between 1 April 2012 and 31 March 2015 of patients who were initiated on the oral anticoagulant therapy. Data were analysed descriptively and with independent Student's t test and Chi square test to explore if there was an association between type of oral anticoagulant initiated and sex, age, type of prescriber and prior aspirin use. The early uptake of DOACs significantly increased over the study period (p < 0.0001; medium size effect φc = 0.372). There was no statistically significant difference between sex or age and type of oral anticoagulant initiated. Primary-care prescribers were responsible for initiating the majority of oral anticoagulants (71%; N = 257) and driving the use of DOACs (72%, N = 71). Patients switched from aspirin to an oral anticoagulant were more likely to be initiated on warfarin thana DOAC. The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers in this particular CCG.

Prior aspirin and/or nonsteroidal anti-inflammatory drug use in sepsis patients is associated with reduced intensive care unit morbidity and mortality: retrospective study

IntroductionSepsis is a life-threatening condition that is characterized by multi-organ dysfunction and a high mortality rate, and prevention may be cheaper and easier than treatment. The sequential organ failure assessment (SOFA) score is associated with mortality risk, and the Quick SOFA (qSOFA) is a shortened version. In this study, we examined whether there was any difference between the qSOFA and SOFA scores, procalcitonin and CRP levels, and mortality among patients with sepsis who either used or did not use aspirin and/or nonsteroidal anti-inflammatory drug (NSAID).Material and methodsThis study was designed as a retrospective analysis of 64 septic patients, 38 males and 26 females. SOFA, qSOFA and APACHE II scores, as well as gender, age, length of hospital stay, procalcitonin and CRP levels, blood culture results, mortality rates and the use of aspirin and/or NSAID were recorded from the files.ResultsThe median age of aspirin and/or NSAID users was 63 years and of non-users was 55. There were significant differences in the SOFA scores and mortality rates between aspirin and/or NSAID users and non-NSAID/aspirin users (p &lt; 0.05). There were no significant differences in the length of hospital stay or blood culture results (p &gt; 0.05). There were also significant differences in CRP and procalcitonin values (p &lt; 0.05).ConclusionsIn this study, patients that used aspirin and/or NSAID had lower SOFA, qSOFA and APACHE II scores and lower mortality rates. There have been recent studies on the prevention of sepsis in patients having already used these drugs before hospital admission, but there have been no publications in which sepsis is supported by SOFA and qSOFA scores with aspirin and/or NSAID users.