Racial/Ethnic Parity in Low-Dose Aspirin for Women With History of Preeclampsia After National Recommendations [26C]

2020 ◽  
Vol 135 ◽  
pp. 36S
Author(s):  
Julianne Lauring ◽  
Estefania Santamaria Flores ◽  
Hannah Brewster
Keyword(s):  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Racial Ethnic

scholarly journals Digital ischaemia secondary to adalimumab-induced antiphospholipid syndrome

2020 ◽  
Vol 13 (2) ◽  
pp. e232907 ◽  
Author(s):  
Shashank Cheemalavagu ◽  
Sara S McCoy ◽  
Jason S Knight
Keyword(s):  
Antiphospholipid Syndrome ◽  
Low Dose ◽  
Antiphospholipid Antibody ◽  
Antibody Testing ◽  
Left Hand ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Digital Ischaemia ◽  
Necrosis Factor

A 50-year-old woman with a history of Crohn’s disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.

Pregnancy and Stroke

CNS Spectrums ◽  
2005 ◽  
Vol 10 (7) ◽  
pp. 580-587 ◽  
Author(s):  
Ann K. Helms ◽  
Steven J. Kittner
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Postpartum Period ◽  
Low Dose ◽  
Paradoxical Embolism ◽  
Subsequent Pregnancy ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
History Of

AbstractThe risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.

Low-Dose Aspirin after an Episode of Haemorrhagic Stroke Is Associated with Improved Survival

2017 ◽  
Vol 117 (12) ◽  
pp. 2396-2405 ◽  
Author(s):  
Antonio González-Pérez ◽  
David Gaist ◽  
Francisco de Abajo ◽  
María Sáez ◽  
Luis García Rodríguez
Keyword(s):  
Low Dose ◽  
Haemorrhagic Stroke ◽  
Antiplatelet Drug ◽  
Cox Proportional Hazard ◽  
Dose Aspirin ◽  
Hazard Ratios ◽  
Low Dose Aspirin ◽  
Prior Use ◽  
History Of ◽  
Cox Proportional Hazard Models

AbstractWe aimed at investigating how antiplatelet drug use affected mortality in patients with a history of haemorrhagic stroke (HS). Thus, starting 30 days after an HS episode, we followed 1,004 patients with intracerebral haemorrhage (ICH) and 929 patients with subarachnoid haemorrhage (SAH) for a median of 6.4 years. We estimated the effect of time-dependent exposure to antiplatelets after HS on all-cause mortality. Cox proportional hazard models were used to compute adjusted hazard ratios (aHRs) and 95% confidence intervals (CI).We found that current use of low-dose aspirin was associated with a 32% improved survival (aHR = 0.68; 95% CI: 0.53–0.88), with a similar association among ICH (aHR = 0.66; 95% CI: 0.49–0.89) and SAH (aHR = 0.61; 95% CI: 0.36–1.04) patients. A statistically significant improved survival associated with current use of low-dose aspirin during follow-up was only observed among individuals who used antithrombotic drugs in the year before the HS (prior use: aHR = 0.56; 95% CI: 0.39–0.80; non-prior use: aHR = 0.87; 95% CI: 0.61–1.24). Current use of clopidogrel was not associated with survival (aHR = 1.35; 95% CI: 0.88–2.08). Statin use was associated with improved survival (aHR = 0.38; 95% CI: 0.31–0.47). On the other hand, discontinuation of statins (aHR = 1.31; 95% CI: 1.02–1.68) or low-dose aspirin (aHR = 1.54; 95% CI: 1.21–1.97) was associated with decreased survival. In our study, use of low-dose aspirin after an episode of HS to reduce vascular risks is safe, particularly in patients who were on antithrombotic therapy before the episode. Our results suggest an improved survival associated with low-dose aspirin. This finding must be interpreted with care due to the observational nature of the study, and warrants further studies.

scholarly journals Low-dose aspirin-associated upper gastric and duodenal ulcers in Japanese patients with no previous history of peptic ulcers

2013 ◽  
Vol 6 (1) ◽  
pp. 455 ◽  
Author(s):  
Naohiko Kawamura ◽  
Yoshitsugu Ito ◽  
Makoto Sasaki ◽  
Akihito Iida ◽  
Mari Mizuno ◽  
...  
Keyword(s):  
Low Dose ◽  
Previous History ◽  
Japanese Patients ◽  
Peptic Ulcers ◽  
Duodenal Ulcers ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized controlled trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage

Blood ◽  
2010 ◽  
Vol 115 (21) ◽  
pp. 4162-4167 ◽  
Author(s):  
Peter Clark ◽  
Isobel D. Walker ◽  
Peter Langhorne ◽  
Lena Crichton ◽  
Andrew Thomson ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Low Dose ◽  
Loss Rate ◽  
Controlled Trial ◽  
Previous Pregnancy ◽  
Randomized Controlled ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Multicenter Randomized Controlled Trial ◽  
History Of

To assess whether treatment with enoxaparin and low-dose aspirin, along with intensive pregnancy surveillance, reduces rate of pregnancy loss compared with intensive pregnancy surveillance alone in women with history of 2 or more consecutive previous pregnancy losses, a parallel group, multicenter, randomized controlled trial was performed in the United Kingdom and New Zealand. Participants (n = 294) presenting for initial antenatal care at fewer than 7 weeks' gestation with history of 2 or more consecutive previous pregnancy losses at 24 or fewer weeks' gestation and no evidence of anatomic, endocrine, chromosomal, or immunologic abnormality were randomly assigned to receive either enoxaparin 40 mg subcutaneously and 75 mg of aspirin orally once daily along with intense pregnancy surveillance or intense pregnancy surveillance alone from random assignment until 36 weeks' gestation. The primary outcome measure was pregnancy loss rate. Of the 147 participants receiving pharmacologic intervention, 32 (22%) pregnancy losses occurred, compared with 29 losses (20%) in the 147 subjects receiving intensive surveillance alone, giving an odds ratio of 0.91 (95% confidence interval, 0.52-1.59) of having a successful pregnancy with pharmacologic intervention. Thus, we observed no reduction in pregnancy loss rate with antithrombotic intervention in pregnant women with 2 or more consecutive previous pregnancy losses. The trial was registered at http://www.controlled-trials.com as ISRCTN06774126.

VKORC1-1639 G>A Polymorphism and the Risk of Non-Variceal Upper Gastrointestinal Bleeding

2017 ◽  
Vol 26 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Ioana Groza ◽  
Dana Matei ◽  
Marcel Tanţău ◽  
Adrian P Trifa ◽  
Sorin Crişan ◽  
...  
Keyword(s):  
Risk Factor ◽  
Alcohol Consumption ◽  
Vitamin K ◽  
Low Dose ◽  
Upper Gastrointestinal Bleeding ◽  
Aspirin Therapy ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Upper Gastrointestinal

Background & Aims: The mutations in the gene that encodes vitamin K epoxide reductase (VKOR) enzyme are responsible for low levels of vitamin K. The purpose of this study was to evaluate whether the presence of the VKORC1 -1639 G> A polymorphism is a risk factor for non-variceal upper gastrointestinal bleeding (UGIB) in patients without concomitant therapy with vitamin K antagonists.Methods: This case-control study comprised 163 consecutive patients diagnosed with UGIB and 178 controls, in whom the diagnosis of UGIB was excluded. The following data were recorded: age, gender, alcohol consumption, smoking, history of UGIB, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin consumption. Genetic analysis included genotyping for the VKORC1 -1639 G>A polymorphism.Results: History of UGIB (OR 3.463, CI95% 1.463-8.198, p=0.005), smoking (OR 2.498, CI95% 1.358-4.597, p=0.003), alcohol consumption (OR 3.283, CI95% 1.796-6.000, p<0.001), use of NSAIDs (OR 4.542, CI95% 2.502-8.247, p<0.001) or of low-dose aspirin (OR 2.390, CI95% 1.326-4.310), and the VKORC1 -1639 G> A AA genotype (OR 1.364, CI95% 0.998-1.863, p=0.05) were associated with an increased risk of UGIB. The risk of UGIB was analyzed in patients with genotype AA who used aspirin or NSAIDs. The genotype AA has not kept its status of independent risk factor (p=0.3). In subjects with NSAIDs/aspirin therapy and genotype AA there was a two times higher chance of UGIB compared to those under NSAIDs/aspirin therapy alone (OR 7.6 vs. 3.6, p<0.001).Conclusion: Patients with non-variceal UGIB caused by the use of NSAIDs or low-dose aspirin are more frequent carriers of the VKORC1 -1639 G>A AA genotype, as compared to those without UGIB.

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 Impact of Blood Type, Functional Polymorphism (T-1676C) of theCOX-1Gene Promoter and Clinical Factors on the Development of Peptic Ulcer during Cardiovascular Prophylaxis with Low-Dose Aspirin

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Pin-Yao Wang ◽  
Hsiu-Ping Chen ◽  
Angela Chen ◽  
Feng-Woei Tsay ◽  
Kwok-Hung Lai ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Low Dose ◽  
Gene Promoter ◽  
Blood Type ◽  
Functional Polymorphism ◽  
Clinical Factors ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of ◽  
Cox 1

Aims. To investigate the impact of blood type, functional polymorphism (T-1676C) of theCOX-1gene promoter, and clinical factors on the development of peptic ulcer during cardiovascular prophylaxis with low-dose aspirin.Methods. In a case-control study including 111 low-dose aspirin users with peptic ulcers and 109 controls (asymptomatic aspirin users), the polymorphism (T-1676C) of theCOX-1gene promoter was genotyped, and blood type,H pyloristatus, and clinical factors were assessed.Results. Univariate analysis showed no significant differences in genotype frequencies of theCOX-1gene at position -1676 between the peptic ulcer group and control group. Multivariate analysis revealed that blood type O, advanced age, history of peptic ulcer, and concomitant use of NSAID were the independent risk factors for the development of peptic ulcer with the odds ratios of the 2.1, 3.1, 27.6, and 2.9, respectively.Conclusion. The C-1676T polymorphism in theCOX-1gene promoter is not a risk factor for ulcer formation during treatment with low-dose aspirin. Blood type O, advanced age, history of peptic ulcer, and concomitant use of NSAID are of independent significance in predicting peptic ulcer development during treatment with low-dose aspirin.

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

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