scholarly journals Rationality and safety of acetylsalicylic acid therapy in centenarians

2021 ◽  
pp. 379-382
Author(s):  
E. R. Alimova ◽  
K. A. Eruslanova
Keyword(s):  
Gastrointestinal Bleeding ◽  
Acetylsalicylic Acid ◽  
Clinical Guidelines ◽  
Complete Blood Count ◽  
Bleeding Risk ◽  
Acid Therapy ◽  
Additional Risk ◽  
Number Of Patients ◽  
History Of ◽  
Inflammatory Drugs

Aim. To assess the presence or absence of indications for taking acetylsalicylic acid (ASA), as well as the safety of therapy among centenarians according to clinical guidelines.Materials and methods. The study included 81 patients (71 women and 10 men). Inclusion criteria: patients 95 years and older (mean age 98.3 ± 1.89) receiving combination therapy, including ASA. In the study, the patients' history data on concomitant diseases and pharmacotherapy were assessed, a comprehensive examination (complete blood count (CBC), echocardiography) was performed. In our work, the results of these studies were analyzed, and statistical calculations were performed.Results. From the total number of patients included in the study, 41.9% regularly take ASA (n=34). In 41.7% (n=14) were taken as secondary prevention of cardiovascular events (the presence of a documented history of cardiovascular disease). According to current recommendations, 58.3% (n=20) of patients had no indications for a prescription. During the analysis among patients for whom according to clinical guidelines ASA therapy was not recommended, groups were identified in which the risk of gastrointestinal bleeding (GIB) was increased: 30% (n=6) patients had a history of gastric ulcer or duodenal ulcer, 20% (n=4) took drugs from the group of non-steroidal anti-inflammatory drugs, 25% (n=3) of patients had thrombocytopenia. In 4 (15.6%) patients from these subgroups, several factors simultaneously increase gastrointestinal bleeding risk.Conclusions. From the total number of patients included in the study and prescribed with ASA, more than half had no indications for therapy; the vast majority of this group had additional risk factors for GIB development. At the same time, a quarter of all participants had indications, but therapy was not prescribed. Summarizing all of the mentioned above, before prescribing and continuing treatment with ASA, clinicians should analyze the therapy's feasibility and safety.

scholarly journals The use of recombinant activated factor VII in the treatment of gastrointestinal bleeding following acetylsalicylic acid therapy in a surgical patient

2008 ◽  
Vol 136 (Suppl. 3) ◽  
pp. 240-245 ◽  
Author(s):  
Dragica Vucelic ◽  
Predrag Sabljak ◽  
Predrag Pesko ◽  
Dejan Stojakov ◽  
Keramatollah Ebrahimi ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Acetylsalicylic Acid ◽  
Acid Treatment ◽  
Haemorrhagic Shock ◽  
Factor Vii ◽  
Surgical Patient ◽  
Recombinant Activated Factor Vii ◽  
Acid Therapy ◽  
Activated Factor Vii ◽  
Massive Gastrointestinal Bleeding

INTRODUCTION. Gastrointestinal bleeding is the most important complication associated with acetylsalicylic acid therapy. Patients with preexisting haemostatic disorders are at the higher risk and may experience life-threatening hemorrhagic syndrome. Platelet transfusions and desmopressin administration commonly successfully arrest bleeding. However, in clinical situations with profound bleeding and haemorrhagic shock, these therapeutic approaches may fail. CASE OUTLINE. We report a 24-year old female patient with previously undetected acquired platelet dysfunction, who underwent reconstructive surgical intervention. On the 20th postoperative day, acetylsalicylic acid was introduced due to reactive thrombocytosis (platelet count 1480x109/L) with daily dose of 100 mg tablets. On the 12th day of the acetylsalicylic acid treatment, massive gastrointestinal bleeding with haemorrhagic shock suddenly occurred. Attempts to control massive haemorrhage by resuscitation, blood products and haemostatics (desmopressin, tranexamic acid) failed. Two bolus doses of recombinant activated factor VII (rFVIIa) (100 ?g/kg and 60 ?g/kg respectively) in 90 minutes interval were given. Bleeding was successfully controlled with no requirements for further haemoproducts and haemostatic remedies treatment. CONCLUSION. This case demonstrates that the use of rFVIIa may be a specific treatment option in patients suffering from severe gastrointestinal bleeding associated with acetylsalicylic acid treatment.

Dabigatran etexilate and concomitant use of non-steroidal anti-inflammatory drugs or acetylsalicylic acid in patients undergoing total hip and total knee arthroplasty: No increased risk of bleeding

2012 ◽  
Vol 108 (07) ◽  
pp. 183-190 ◽  
Author(s):  
Andreas Kurth ◽  
Andreas Clemens ◽  
Herbert Noack ◽  
Bengt Eriksson ◽  
Joseph Caprini ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Knee Arthroplasty ◽  
Major Bleeding ◽  
Dabigatran Etexilate ◽  
Bleeding Risk ◽  
Total Hip ◽  
Increased Risk ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

SummaryPatients undergoing total hip or knee arthroplasty should receive anticoagulant therapy because of the high risk of venous thromboembolism. However, many are already taking non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) that can have antihaemostatic effects. We assessed the bleeding risk in patients treated with thromboprophylactic dabigatran etexilate, with and without concomitant NSAID or ASA. A post-hoc analysis was undertaken of the pooled data from trials comparing dabigatran etexilate (220 mg and 150 mg once daily) and enoxaparin. Major bleeding event (MBE) rates were determined and odds ratios (ORs) generated for patients who received study treatment plus NSAID (half-life ≤12 hours) or ASA (≤160 mg/day) versus study treatment alone. Relative risks were calculated for comparisons between treatments. Overall, 4,405/8,135 patients (54.1%) received concomitant NSAID and 386/8,135 (4.7%) received ASA.ORs for the comparison with/without concomitant NSAID were 1.05 (95% confidence interval [CI] 0.55–2.01) for 220 mg dabigatran etexilate; 1.19 (0.55–2.55) for 150 mg; and 1.32 (0.67–2.57) for enoxaparin. ORs for the comparison with/without ASA were 1.14 (0.26–5.03); 1.64 (0.36–7.49); and 2.57 (0.83–7.94), respectively. For both NSAIDs and ASA there was no significant difference in bleeding between patients with and without concomitant therapy in any treatment arm. Patients concomitantly taking NSAIDs or ASA have a similar risk of MBE to those taking dabigatran etexilate alone. No significant differences in MBE were detected between dabigatran etexilate and enoxaparin within comedication subgroups, suggesting that no increased major bleeding risk exists when dabigatran etexilate is administered with NSAID or ASA.Investigation performed at multiple centres participating in the RE-MODEL™, RE-NOVATE®, and RE-MOBILIZE® trials.

scholarly journals Acetylsalicylic acid therapy in patients undergoing planned surgery

2015 ◽  
Vol 6 (3) ◽  
pp. 48-57
Author(s):  
S. S Altarev ◽  
O. L Barbarash
Keyword(s):  
Cardiovascular Risk ◽  
Acetylsalicylic Acid ◽  
Perioperative Period ◽  
Bleeding Risk ◽  
Aspirin Therapy ◽  
The Other ◽  
Acid Therapy ◽  
Risks And Benefits ◽  
Other Hand

In a review, we described risks and benefits of surgery performed while continuing aspirin therapy in perioperative period. Aspirin therapy is associated with mild increase in surgery related bleeding risk. On the other hand, aspirin therapy leads to significant decrease of mortality and perioperative cardiovascular risk in most cases.

scholarly journals Surgical procedures in patients on aspirin. Literature Review

2021 ◽  
pp. 57-72
Author(s):  
Stella Papamimikou ◽  
◽  
Nikolaos Kolomvos ◽  
Nadia Theologie-Lygidakis
Keyword(s):  
Surgical Procedures ◽  
Bleeding Risk ◽  
Chronic Medication ◽  
Antiplatelet Medication ◽  
Anticoagulant Drugs ◽  
History Of ◽  
Inflammatory Drugs ◽  
The Common ◽  
Anti Inflammatory ◽  
Prosthetic Surgery

Aspirin is referred to as the original of the common non-steroid anti-inflammatory drugs and is used as a comparison measure to new ones. Aspirin, whose active ingredient is acetylsalicylic acid, combines strong antipyretic, analgesic, anti-inflammatory and anti-coagulant action. For the latter, aspirin is administered on an ongoing basis to patients for the prevention of cardiovascular events or recurrence of cerebral throm- bosis and therapeutically to patients with a history of heart attack or ischemic stroke. Taking aspirin as an anticoagulant chronic medication concerns dentists es- pecially when it comes to surgical procedures as it is likely to cause increased bleeding perioperatively. The management of the patient on aspirin varies depending on the reason aspirin is administered and its dosage, the co-administration of other antiplatelet or anticoagulant drugs and the severity of the surgical procedure itself. An interruption of antiplatelet medication is decided after assessing the above-mentioned criteria and con- sulting the patient’s physician. Additionally, in cases of increased bleeding risk like complex extractions, pre- prosthetic surgery, periodontal surgery, the procedure needs to be performed as atraumatically as possible and be accompanied by local haemostatic measures.

Severe nose bleeding after intake of acetylsalicylic acid: von Willebrand disease type 2A

2003 ◽  
Vol 23 (03) ◽  
pp. 135-137
Author(s):  
B. Mansouri Taleghani ◽  
W. A. Wuillemin ◽  
N. X. von der Weid
Keyword(s):  
Acetylsalicylic Acid ◽  
Laboratory Diagnosis ◽  
Inhibitory Effect ◽  
Von Willebrand Disease ◽  
Bleeding Disorders ◽  
Laboratory Findings ◽  
History Of ◽  
Inflammatory Drugs ◽  
Von Willebrand

SummaryThis case report of a school boy with a history of severe and repeated episodes of epistaxis presents a short overview of the clinical and laboratory findings which lead to confirm the suspected diagnosis of von Willebrand disease (vWD). Suspicion of defective primary haemostasis should arise when unusual (because of their number or duration) mucosal bleeds appear in an otherwise normal and healthy patient. Because of its definitive inhibitory effect on platelet aggregation, acetylsalicylic acid (more than other non-steroidal anti-inflammatory drugs exerting unselective inhibition of cyclooxygenase) is a strong factor in triggering or sustaining the bleeding disorders in these patients. Among the congenital disorder of primary haemostasis, vWD is by far the most frequent one.The difficulties of laboratory diagnosis of vWD are stressed; the promises and pitfalls of new in vitro methods for measuring primary haemostasis (PFA-100® analyzer) are discussed. An accurate diagnosis of the specific type of vWD is of critical importance for correct patient management as well as for genetic counseling.

scholarly journals Patients With Atrial Fibrillation Taking Nonsteroidal Anti-Inflammatory Drugs and Oral Anticoagulants in the ARISTOTLE Trial

Circulation ◽  
2020 ◽  
Vol 141 (1) ◽  
pp. 10-20 ◽  
Author(s):  
Frederik Dalgaard ◽  
Hillary Mulder ◽  
Daniel M. Wojdyla ◽  
Renato D. Lopes ◽  
Claes Held ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Clinical Trial Registration ◽  
Risk Of Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) with oral anticoagulants has been associated with an increased risk of bleeding. We investigated the risk of bleeding and major cardiovascular outcomes in patients with atrial fibrillation taking NSAIDs and apixaban or warfarin. Methods: The ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; n=18 201) compared apixaban with warfarin in patients with atrial fibrillation at an increased risk of stroke. Patients in ARISTOTLE without severe renal (creatine clearance ≤30 mL/min) or liver disease were included in this analysis (n=17 423). NSAID use at baseline, NSAID use during the trial (incident NSAID use), and never users were described. The primary outcome was major bleeding. Secondary outcomes included clinically relevant nonmajor bleeding, gastrointestinal bleeding, heart failure hospitalization, stroke or systemic embolism, and all-cause mortality. NSAID use during the trial, and the interaction between randomized treatment, was analyzed using time-dependent Cox proportional hazards models. Results: Those with baseline NSAID use (n=832 [4.8%]), incident NSAID use (n=2185 [13.2%]), and never users were similar in median age (age [25th, 75th]; 70 [64, 77] versus 70 [63, 75] versus 70 [62, 76]). Those with NSAID use at baseline and incident NSAID use were more likely to have a history of bleeding than never users (24.5% versus 21.0% versus 15.6%, respectively). During a median follow-up (25th, 75th) of 1.8 (1.4, 2.3) years and when excluding those taking NSAID at baseline, we found that incident NSAID use was associated with an increased risk of major bleeding (hazard ratio [HR], 1.61 [95% CI, 1.11–2.33]) and clinically relevant nonmajor bleeding (HR, 1.70 [95% CI, 1.16–2.48]), but not gastrointestinal bleeding. No significant interaction was observed between NSAID use and randomized treatment for any outcome. Conclusions: A substantial number of patients in the ARISTOTLE trial took NSAIDs. Incident NSAID use was associated with major and clinically relevant nonmajor bleeding, but not with gastrointestinal bleeding. The safety and efficacy of apixaban versus warfarin appeared not significantly to be altered by NSAID use. This study warrants more investigation of the effect of NSAIDs on the outcomes of patients treated with apixaban. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00412984.

Mortality in patients who discontinue low-dose acetylsalicylic acid therapy after upper gastrointestinal bleeding

2016 ◽  
Vol 26 (2) ◽  
pp. 215-222 ◽  
Author(s):  
Antonio González-Pérez ◽  
María Eugenia Sáez ◽  
Saga Johansson ◽  
Péter Nagy ◽  
Luis A. García Rodríguez
Keyword(s):  
Gastrointestinal Bleeding ◽  
Acetylsalicylic Acid ◽  
Low Dose ◽  
Upper Gastrointestinal Bleeding ◽  
Acid Therapy ◽  
Upper Gastrointestinal

scholarly journals Risk of Postoperative Gastrointestinal Bleeding and Its Associated Factors: A Nationwide Population-Based Study in Korea

2021 ◽  
Vol 11 (11) ◽  
pp. 1222
Author(s):  
Sang Hyuck Kim ◽  
Kyungdo Han ◽  
Gunseog Kang ◽  
Seung Woo Lee ◽  
Chi-Min Park ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Associated Factors ◽  
Postoperative Bleeding ◽  
Bleeding Risk ◽  
Population Based ◽  
Older Age ◽  
Ulcer Disease ◽  
Increased Risk ◽  
Icd 10 ◽  
Inflammatory Drugs

Postoperative gastrointestinal bleeding (PGIB) is a serious complication with expensive medical costs and a high mortality rate. This study aims to analyze the incidence of PGIB and its associated factors, including its relationship with postoperative analgesic use. Patients aged ≥20 years who received various kinds of surgery from 2013 to 2017 were included (n = 1,319,807). PGIB was defined by admission with ICD-10 codes of gastrointestinal bleeding plus transfusion within 2 months after surgery. A total of 3505 (0.27%) subjects had PGIB, and the incidence was much higher for those who underwent major gastrointestinal and major cardiovascular surgery (1.9% for both), followed by major head and neck (0.7%), major genitourinary (0.5%), and orthopedic surgery (0.45%). On multivariate analysis, older age, male sex, lower income, comorbidities, peptic ulcer disease, and congestive heart failure were associated with a higher risk of gastrointestinal bleeding. Among analgesics, steroid use was associated with increased postoperative bleeding risk (adjusted OR: 1.36, 95% CI: 1.25–1.48). Acetaminophen/nonsteroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors, anticonvulsants, antidepressants, and opioids were not associated with increased risk. PGIB is considerable for major surgeries, and its risk should be considered, especially for patients with older age and comorbidities and use of steroids.

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