scholarly journals 95 Long-term dual antiplatelet therapy after myocardial infarction in clinical practice: impact of nuisance bleeding on medication adherence

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gennaro Ratti ◽  
Cristina Di Tommaso ◽  
Cinzia Monda ◽  
Ciro Elettrico ◽  
Federica Ratti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medication Adherence ◽  
High Risk ◽  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Abstract Aims Long-term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS) for the secondary prevention of atherothrombotic events in high-risk patients with a history of myocardial infarction of at least 1 year. Long-term dual antiplatelet therapy (DAPT) had a well tolerability and safety profile, but the risk of TIMI major bleeding was significantly increased. However even nonsignificant bleeding may be important because have an effect on quality of life and therefore may lead to treatment discontinuation. To understand the experiences of patients with long-term DAPT with ticagrelor 60 mg and low-dose aspirin and nuisance bleeding, and their impact of nuisance bleeding on medication adherence. Methods and results We retrospectively reviewed aggregate data of 187 patients (155 M e 38 F) (mean age 63.8 ± 9 years) in follow-up after ACS with at least one high risk condition (multivessel disease, diabetes, GFR < 60 mL/min, history of prior myocardial infarction, age > 65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The high risk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), and >65 year aged 85 pts (45%). The outpatient follow-up programme after hospitalization provides visits at day 30 after discharge and subsequently after 3 months, then continuing with 6-monthly checks. The intensity of bleeding was assessed according to the TIMI score.1 Any overt bleeding event that did not meet the criteria of major and minor was defined ‘minimal’. Treatment was withdrawn in seven patients: three cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding. In three patients, a temporary withdrawal was due to surgery (one colon polyposis and two cases of bladder papilloma). Minimal bleedings (nasal, gingival, conjunctival, subcutaneous/dermal, rectal and urinary) were present in 31 patients, but were not a cause for discontinuation of therapy. However, 22 (70%) subjects had asked opinion on stop the therapy at the telephone consultation. We found that: (i) participants adhered to treatment when they believed long-term DAPT was important to health outcomes; (ii) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (iii) participants’ and their family’s understanding of long-term DAPT risks and benefits, and their ability to manage symptoms, influenced medication adherence. Factors influencing long-term DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital. Conclusions All adverse events judged to be ‘not serious’ in trials may have an effect on quality of life and therefore may lead to treatment discontinuation. The need to educate the patient in order to improve adherence should therefore be emphasized. The authors underline the importance of careful outpatient follow-up and constant counselling in order to check out compliance and possible adverse effect of long term DAPT risks treatment.

Long-term persistence to low-dose aspirin for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Vora ◽  
M Soriano-Gabarro ◽  
B Russell ◽  
H Morgan Stewart
Keyword(s):  
Index Date ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Routine Clinical Practice ◽  
Vascular Events ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Cvd Prevention

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). Discontinuation of low-dose aspirin is associated with increased risk of ischaemic vascular events. However, data on long-term persistence to low-dose aspirin from routine clinical practice are limited. Purpose To assess the long-term persistence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Persistence was calculated if the gap between two prescriptions exceeds 60 days. Patients with such gaps still receiving prescription after 60 days were plotted based on the number of gaps identified during the follow-up and if no prescription was recorded then they were considered discontinued. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Persistence at two years with a few gaps was 67% and 59% in UK and DE for secondary CVD prevention; 57% and 53% for primary CVD prevention, respectively. With multiple Gaps, 50% and 36% still receive prescription low-dose aspirin for 10 years in UK and DE, respectively for secondary CVD prevention. For Primary prevention, 36% and 32% receive prescription of aspirin for 10 years with multiple gaps in UK and DE (Figure). Conclusion After the initial drop in persistence the patients tend to continue their low-dose aspirin treatment for long-term, although with multiple gaps. Overall, the persistence was higher in secondary compared to primary CVD prevention. Improving persistence to low-dose aspirin therapy in the initial years may help in continuity of their treatment over long-term. Persistence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

scholarly journals Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial

Diabetes Care ◽  
2019 ◽  
Vol 43 (2) ◽  
pp. 314-320 ◽  
Author(s):  
Chisa Matsumoto ◽  
Hisao Ogawa ◽  
Yoshihiko Saito ◽  
Sadanori Okada ◽  
Hirofumi Soejima ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trial ◽  
Low Dose ◽  
Follow Up Study ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Long Term Follow Up

scholarly journals Alternate-Day, Low-Dose Aspirin and Cancer Risk: Long-Term Observational Follow-up of a Randomized Trial

2013 ◽  
Vol 159 (2) ◽  
pp. 77 ◽  
Author(s):  
Nancy R. Cook ◽  
I-Min Lee ◽  
Shumin M. Zhang ◽  
M. Vinayaga Moorthy ◽  
Julie E. Buring
Keyword(s):  
Cancer Risk ◽  
Randomized Trial ◽  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Low-Dose Aspirin and Sporadic Anovulation in the EAGeR Randomized Trial

2016 ◽  
Vol 102 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Rose G. Radin ◽  
Lindsey A. Sjaarda ◽  
Neil J. Perkins ◽  
Robert M. Silver ◽  
Zhen Chen ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Low Dose ◽  
Controlled Trial ◽  
Double Blind ◽  
Menstrual Cycles ◽  
Spot Urine ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Abstract Context: Among women with a single, recent pregnancy loss, daily preconception low-dose aspirin (LDA) increased the live birth rate with no effect on pregnancy loss. Ovulation is a potential mechanism underlying this effect. Objective: We estimated the effect of LDA on the per-cycle risk of anovulation among eumenorrheic women. Design: Multicenter, randomized, double-blind, placebo-controlled trial of daily LDA on reproductive outcomes. Preconception follow-up lasted 1 to 6 menstrual cycles (ClinicalTrials.gov, NCT00467363). Setting: Four US medical centers during 2007 to 2011. Patients or Other Participants: Healthy women (n = 1214), age 18 to 40, were attempting pregnancy, had regular menstrual cycles (21 to 42 days), and had a history of 1 to 2 documented pregnancy losses, ≤2 live births, and no infertility. All participants completed at least 1 menstrual cycle of follow-up; none withdrew due to adverse events. Intervention: Aspirin (81 mg) daily for 1 to 6 menstrual cycles. Main Outcome Measure: Per-cycle risk of anovulation, defined as the absence of both a positive spot-urine pregnancy test and a luteinizing hormone (LH) peak (2.5-fold increase in daily urinary LH). Hypothesis formulation preceded data collection. Results: Among 4340 cycles, LDA was not associated with anovulation (LDA: 13.4%, placebo: 11.1%; risk ratio = 1.16, 95% confidence interval, 0.88 to 1.52). Results were similar among women with a single, recent loss. Conclusions: Daily LDA had no effect on anovulation among women with a history of 1 to 2 pregnancy losses. LDA may affect fertility via other pathways, and these warrant further study.

scholarly journals AB0295 TREATMENT OF HIGH RISK/REFRACTORY OBSTETRIC ANTIPHOSPHOLIPID SYNDROME. A SINGLE CENTRE EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1174.1-1174
Author(s):  
A. Hoxha ◽  
P. Marson ◽  
M. Favaro ◽  
M. Tonello ◽  
M. Zen ◽  
...  
Keyword(s):  
High Risk ◽  
Antiphospholipid Syndrome ◽  
Pregnancy Complications ◽  
Low Dose ◽  
Treatment Protocol ◽  
Line Treatment ◽  
Second Line ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Background:The most efficacious strategy to manage pregnant patients with antiphospholipid syndrome (APS) who are at high risk of adverse pregnancy outcomes ± refractory to conventional heparin/low-dose aspirin treatment is currently unknown (1, 2).Objectives:The purposes of this study were to investigate the efficacy and safety of a second-line treatment protocol administered in addition to twice daily low molecular weight heparin and low-dose aspirin to pregnant patients affected with high-risk ± refractory primary APS.Methods:Patients were included in the study if satisfying the following criteria were: 1) the presence of triple antiphospholipid antibody positivity (IgG/IgM anticardiolipin + IgG/IgM anti-β2 Glycoprotein I antibodies + lupus anticoagulant), 2) previous thrombosis and/or a history of one or more early and severe pregnancy complications. The second-line treatment protocol included weekly plasmapheresis or immunoadsorption and fortnightly 1g/kg intravenous immunoglobulins.Results:Twenty-four pregnancies occurring between 2002 and 2019 in 19 primary APS patients, (mean age 35.1 ± 3.5 SD) were monitored. Triple antiphospholipid positivity was detected in all 19 cases (100%). Seven of these women (36.8%) had a history of thrombosis, five (26.3%) one or more previous failed pregnancies associated to severe pregnancy complications and seven (36.8%) both clinical criteria. Twenty- three pregnancies (95.8%) produced live neonates (13 females and 10 males), all born between the 26th and 38th week of gestation (mean 33.6 ± 3.5 SD); birth weight percentile was 35.8 ± 24.1 SD and mean Apgar score at 5 min 8.7 ± 1.1 SD. Due to premature birth (24th week) complicated by fetal sepsis, one pregnancy (4.2%) had a negative outcome. During the treated pregnancy there were no episodes of thrombosis; there were five cases (20.8%) of severe maternal complications during pregnancy or puerperium and four of fetal complications (16.6%), all followed by complete recovery after delivery. No side-effects of the treatment were registered.Conclusion:Given the high live birth rate and the safety associated to it, the second-line treatment protocol described here could be taken into consideration when the treatment of a high-risk APS pregnancy ± refractory to conventional therapy is being evaluated.References:[1]Tektonidou MG, et al. Ann Rheum Dis 2019;0:1–9. doi:10.1136/annrheumdis-2019-215213[2]Giacomelli et al. Autoimmun Rev. 2020;102738. doi.org/10.1016/j.autrev.2020.102738Disclosure of Interests:None declared

Long-term adherence to low-dose aspirin therapy for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Vora ◽  
M Soriano-Gabarro ◽  
B Russel ◽  
H Morgan Stewart
Keyword(s):  
United Kingdom ◽  
Index Date ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Funding Source ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Cvd Prevention

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). However, adherence to therapy is likely an important factor for these benefits to be seen and non-adherence is associated with sub-optimal outcomes. Purpose To assess the long-term adherence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network Database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Adherence was calculated using medication possession ratio (MPR) which is number of days of medication supplied within the refill interval divided by number of days in the refill interval. Long term adherence was divided in three categories namely patients with ≤2 years, 2-≤5 years, and 5-≤10 years of follow-up. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years of follow-up was 88% and 80% for secondary CVD prevention, respectively; 84% and 74% for 2-≤5 years; and 75% and 59% for 5-≤10 years, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years was 76% and 75% for potential primary CVD prevention; 65% and 66% for 2-≤5 years; 49% and 49% for 5-≤10 years, respectively (Figure). Conclusion The long-term adherence to low dose aspirin was quite high with more than half the patients being adherent to their treatment. Overall, the adherence was higher in secondary compared to primary CVD prevention. The estimates for adherence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

scholarly journals Effect of omega 3 fatty acids plus low dose aspirin as a host modulating agent in the treatment of periodontitis patients- A Systematic Review

2021 ◽  
Vol 6 (2) ◽  
pp. 68-71
Author(s):  
Pooja Naik ◽  
◽  
Amit Benjamin ◽  
Shukra Paralkar ◽  
◽  
...  
Keyword(s):  
Systematic Review ◽  
Fatty Acids ◽  
Low Dose ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Pocket Depth ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Background and Objectives: Host Modulatory Therapy is a treatment modality for periodontal diseases. It aims at reducing the periodontal destruction and enhances the regenerative capacity of periodontal tissues. Various host modulating agents are used as an adjunct to scaling and root planing. Omega 3 Fatty acids and non-steroidal anti-inflammatory drugs like Aspirin modify the activity of inflammatory mediators and exert anti-inflammatory effect. The objective of the systematic review was to evaluate the effect of Omega 3 Fatty acids plus low dose Aspirin as adjunct to mechanical debridement in reduction of pocket depth in patients with periodontitis. Methods: In this systematic review, Randomized controlled trials in subjects with periodontitis in age group of 25-70 years were considered. Follow up period ranged from 6 weeks to 6 months. A systematic review of literature was performed using Pubmed, PMC, Google scholar, EBSCO host databases. Studies concerning the use of Omega 3 Fatty acids plus low dose Aspirin as host modulating agent in periodontitis treatment were selected. A total 2650 of studies were selected through search strategy and 5 articles which attained the inclusion criteria have been included in present systematic review. Results: Oral supplementation of omega 3 fatty acids in combination of low dose Aspirin as adjunct to mechanical debridement reduces the pocket depth during the 6 weeks to 6 months follow up period. Limitations: There are limited studies which are available. Also there is lack of data evaluating the long term follow up of the intervention. Conclusion: Use of omega 3 fatty acids and low dose aspirin in periodontitis patients improves periodontal status but further long-term studies need to be conducted.

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