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Aspirin primary prevention

Dorairaj Prabhakaran
Among individuals with established CVD, multiple medications (aspirin, blood pressure lowering drugs and statins) are required to manage CVD and it is well established that non adherence to prescribed treatments is substantial in the long term. Such discontinuation of CV-preventive medications and low adherence rates has been shown to affect the success of CVD prevention efforts. In low- and middle income countries only less than 20% patients receive recommended therapy for CVD prevention, but even in high-income countries treatment coverage in the community is only about 50% in those with heart disease and 35% in those with stroke...
September 2016: Journal of Hypertension
Bassam Haddad, Norbert Winer, Yvon Chitrit, Véronique Houfflin-Debarge, Céline Chauleur, Karine Bages, Vassilis Tsatsaris, Alexandra Benachi, Florence Bretelle, Jean-Christophe Gris, Sylvie Bastuji-Garin
OBJECTIVE: To evaluate whether daily enoxaparin, added to low-dose aspirin, started before 14 weeks of gestation reduces placenta-mediated complications in pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation. METHODS: In this open-label multicenter randomized trial, we enrolled consenting pregnant women with previous severe preeclampsia diagnosed before 34 weeks of gestation, gestational age at randomization of 7-13 weeks, singleton pregnancy, and no plan for anticoagulation...
October 6, 2016: Obstetrics and Gynecology
Zhixin Liu, Rachael Moorin, John Worthington, Geoffrey Tofler, Mark Bartlett, Rabia Khan, Yeqin Zuo
BACKGROUND: The National Prescribing Service (NPS) MedicineWise Stroke Prevention Program, which was implemented nationally in 2009-2010 in Australia, sought to improve antithrombotic prescribing in stroke prevention using dedicated interventions that target general practitioners. This study evaluated the impact of the NPS MedicineWise Stroke Prevention Program on antithrombotic prescribing and primary stroke hospitalizations. METHOD AND RESULTS: This population-based time series study used administrative health data linked to 45 and Up Study participants with a high risk of cardiovascular disease (CVD) to assess the possible impact of the NPS MedicineWise program on first-time aspirin prescriptions and primary stroke-related hospitalizations...
October 13, 2016: Journal of the American Heart Association
Joseph A Ladapo, Udo Hoffmann, Kerry L Lee, Adrian Coles, Megan Huang, Daniel B Mark, Rowena J Dolor, Robert A Pelberg, Matthew Budoff, Gardar Sigurdsson, Harry W Severance, Pamela S Douglas
BACKGROUND: Diagnostic testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or functional testing. METHODS AND RESULTS: We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical testing with coronary computed tomographic angiography or functional testing (NCT01174550)...
October 12, 2016: Journal of the American Heart Association
Davide Capodanno, Dominick J Angiolillo
Daily administration of low-dose of aspirin has proven to be beneficial in preventing recurrent cardiovascular events. However, the role of aspirin for primary prevention in patients with no overt cardiovascular disease is more controversial. In fact, in lower risk patients, the modest benefit in reducing serious vascular events can be offset by the increased risk of bleeding, including intracranial and gastrointestinal hemorrhage. Diabetes mellitus (DM) has been associated with a substantially increased risk of both first and recurrent atherothrombotic events, which makes aspirin therapy of potential value in these subjects...
October 11, 2016: Circulation
Ozan Ünlü, Stephane Zuily, Doruk Erkan
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage...
June 2016: Eur J Rheumatol
V Sandys, M Barry
No abstract text is available yet for this article.
2016: Irish Medical Journal
Adina Hayek, Rohina Joshi, Tim Usherwood, Ruth Webster, Baldeep Kaur, Bandana Saini, Carol Armour, Ines Krass, Tracey-Lea Laba, Christopher Reid, Louise Shiel, Charlotte Hespe, Fred Hersch, Stephen Jan, Serigne Lo, David Peiris, Anthony Rodgers, Anushka Patel
BACKGROUND: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification...
2016: Implementation Science: IS
Dhaval Kolte, Wilbert S Aronow, Maciej Banach
INTRODUCTION: Cardiovascular diseases (CVD) remain the leading cause of death worldwide with an estimated 17.5 million deaths per year. Since its initial conception over a decade ago, the use of cardiovascular polypills has gained increasing momentum as a strategy to lower risk factor levels and prevent CVD. Several new data have emerged including the recent publication of the first outcomes trial using polypills. AREAS COVERED: In this review, the authors summarize the current literature on the safety, efficacy, and cost-effectiveness of polypills for primary and secondary prevention of CVD, describe the current controversies in this field, and identify important areas for future research...
September 22, 2016: Expert Opinion on Investigational Drugs
Dorairaj Prabhakaran
Among individuals with established CVD, multiple medications (aspirin, blood pressure lowering drugs and statins) are required to manage CVD and it is well established that non adherence to prescribed treatments is substantial in the long term. Such discontinuation of CV-preventive medications and low adherence rates has been shown to affect the success of CVD prevention efforts. In low- and middle income countries only less than 20% patients receive recommended therapy for CVD prevention, but even in high-income countries treatment coverage in the community is only about 50% in those with heart disease and 35% in those with stroke...
September 2016: Journal of Hypertension
Graeme J Hankey
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis...
September 13, 2016: Lancet
Stephanie A Ward, Parnesh Raniga, Nicholas J Ferris, Robyn L Woods, Elsdon Storey, Michael J Bailey, Amy Brodtmann, Paul A Yates, Geoffrey A Donnan, Ruth E Trevaks, Rory Wolfe, Gary F Egan, John J McNeil
RATIONALE: Cerebral microbleeds seen on brain magnetic resonance imaging are markers of small vessel disease, linked to cognitive dysfunction and increased ischemic and hemorrhagic stroke risk. Observational studies suggest that aspirin use may induce cerebral microbleeds, and associated overt intracranial hemorrhage, but this has not been definitively resolved. AIMS: ASPREE-NEURO will determine the effect of aspirin on cerebral microbleed development over three years in healthy adults aged 70 years and over, participating in the larger 'ASPirin in Reducing Events in the Elderly (ASPREE)' primary prevention study of aspirin...
September 15, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Antoinette de Waha, Sigrid Sandner, Moritz von Scheidt, Andreas Boening, Katharina Koch-Buettner, Dieter Hammel, Rainer Hambrecht, Bernhard C Danner, Friedrich A Schöndube, Gerold Goerlach, Theodor Fischlein, Michael Schmoeckel, Martin Oberhoffer, Rainer Schulz, Thomas Walther, Tibor Ziegelhöffer, Christoph Knosalla, Felix Schönrath, Friedhelm Beyersdorf, Matthias Siepe, Tim Attmann, Martin Misfeld, Friedrich-Wilhelm Mohr, Hans-Hinrich Sievers, Alexander Joost, Leon M Putman, Günther Laufer, Christian Hamm, Uwe Zeymer, Adnan Kastrati, Peter W Radke, Rüdiger Lange, Jochen Cremer, Heribert Schunkert
BACKGROUND: For patients with coronary artery disease undergoing coronary bypass surgery, acetylsalicylic acid (ASA) currently represents the gold standard of antiplatelet treatment. However, adverse cardiovascular event rates in the first year after coronary artery bypass grafting (CABG) still exceed 10%. Graft failure, which is predominantly mediated by platelet aggregation, has been identified as a major contributing factor in this context. Therefore, intensified platelet inhibition is likely to be beneficial...
September 2016: American Heart Journal
Paul E Alexander, Shelly-Anne Li, Marcello Tonelli, Gordon Guyatt
OBJECTIVES: The Canadian Task Force on Preventive Health Care (CTFPHC) produces guidelines for Canadian physicians regarding screening and prevention. To better appreciate the barriers to and facilitators of guideline adherence, we sought to explore physicians' views of guidelines in general and their understanding of this CTFPHC diabetes screening guideline in particular because they pertain to screening and positive treatment. METHODS: We included Canadian physicians (N=10) who agreed to be interviewed regarding their use of guidelines as part of practice, focusing on the CTFPHC 2012 diabetes screening guideline...
August 30, 2016: Canadian Journal of Diabetes
Yuuichi Sakurai, Madoka Shiino, Sayako Horii, Hiroyuki Okamoto, Koki Nakamura, Akira Nishimura, Yukikuni Sakata
BACKGROUND: Gastroprotective agents are recommended for patients receiving low-dose aspirin (LDA) or nonsteroidal anti-inflammatory drugs (NSAIDs). Vonoprazan is a potassium-competitive acid blocker recently approved for the prevention of peptic ulcer recurrence in patients receiving LDA or NSAIDs. METHODS: This phase 2, open-label, single-center study in healthy Japanese males evaluated drug-drug interactions between vonoprazan 40 mg and LDA (100 mg) or NSAIDs [loxoprofen sodium (60 mg), diclofenac sodium (25 mg), or meloxicam (10 mg)] and vice versa...
August 31, 2016: Clinical Drug Investigation
Sae Inoue, Naoko Okiyama, Mari Okune, Nagisa Shiraki, Reiko Kessoku, Manabu Fujimoto
Essential thrombocythemia (ET) is a rare clonal myeloproliferative disorder with a prevalence rate of approximately 1-3 cases per 100 000 individuals per year. ET is characterized by a persistent increase in the platelet count with hyperplasia of bone marrow megakaryocytes. It is difficult to make a diagnosis of ET, because most thrombocythemia are reactive to certain disease conditions including iron deficiency anemia, infection, collagen diseases and malignant tumors. Mutation in the Janus kinase (JAK)2 gene is present in approximately 50-70% of ET patients, and somatic mutations in the calreticulin (CALR) gene were recently discovered in approximately 20-25% of sporadic patients with ET or primary myelofibrosis...
August 29, 2016: Journal of Dermatology
Christopher P Cannon, Savion Gropper, Deepak L Bhatt, Stephen G Ellis, Takeshi Kimura, Gregory Y H Lip, Ph Gabriel Steg, Jurriën M Ten Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll, Jonas Oldgren, Stefan H Hohnloser
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest-sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking...
August 26, 2016: Clinical Cardiology
Paola Patrignani, Carlo Patrono
The place of aspirin in primary prevention remains controversial, with North American and European organizations issuing contradictory treatment guidelines. More recently, the U.S. Preventive Services Task Force recommended "initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years...
August 30, 2016: Journal of the American College of Cardiology
Jin-Sin Koh, Yongwhi Park, Udaya S Tantry, Jong-Hwa Ahn, Min Gyu Kang, Kyehwan Kim, Jeong Yoon Jang, Hyun Woong Park, Jeong Rang Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang, Paul A Gurbel, Young-Hoon Jeong
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely prescribed regimen to prevent ischemic events in patients undergoing percutaneous coronary intervention (PCI). A fixed-dose combination (FDC) capsule (HCP0911) has been developed to provide dosing convenience and improve adherence. We compared the antiplatelet effects of single daily dose HCP0911 with separate treatment with daily 75 mg clopidogrel plus 100 mg aspirin. This was a randomized, open-label, two-period, crossover, non-inferiority study conducted in stented patients who had been treated for at least 6 months with clopidogrel and aspirin...
August 25, 2016: Platelets
Qingyun Mai, Xiaokun Hu, Gang Yang, Yingyi Luo, Kejun Huang, Yuan Yuan, Canquan Zhou
BACKGROUND: Ovarian hyperstimulation syndrome is an iatrogenic complication of controlled ovarian stimulation. Early ovarian hyperstimulation syndrome occurs during luteal phase of controlled ovarian stimulation within 9 days after human chorionic gonadotropin trigger and reflects an acute consequence of this hormone on the ovaries. Late ovarian hyperstimulation syndrome occurs 10 or more days after human chorionic gonadotropin trigger and reflects increased endogenous human chorionic gonadotropin levels following pregnancy...
August 20, 2016: American Journal of Obstetrics and Gynecology
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