2014


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2014/№3

Safety issues in using acetylsalicylic acid drugs for prevention of cardiovascular complications

Minushkina L. O.

Keywords: acetylsalicylic acid, treatment, complications, preventive measures, cardiovascular diseases

DOI: 10.18087/rhj.2014.3.1952

The review describes issues of acetylsalicylic acid (ASA) administration in broad clinical practice. ASA is the most commonly prescribed antiplatelet drug, and the ratio of efficacy to risk of complications is important for its prescription. Possibilities for prevention of gastrointestinal complications are considered. The most important aspect of ASA safety is using the lowest effective doses of the drug. Combinations of ASA with low-dose antacids may make the ASA treatment safer without a significant change in the ASA efficacy. Preventive use of gastric secretion inhibitors and, if indicated, eradication of Helicobacter pylori are possible for patients with high risk of bleeding.
  1. Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34 (38):2949–3003;
  2. Steg PG, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012 Oct;33 (20):2569–619;
  3. Hamm CW, Bassand JP, Agewall S et al. European Society of Cardiology. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. G Ital Cardiol (Rome). 2012 Mar;13 (3):171–228
  4. Mancia G, Fagard R, Narkiewicz K et al. Task Force Members. 2013 ESH / ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013 Jul;31 (7):1281–357.
  5. Zanchetti A, Hansson L, Dahlöf B. Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk.J Hypertens. 2002 Nov;20 (11):2301–7.
  6. Sutcliffe P, Connock M, Gurung T et al. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of. Health Technol Assess. 2013 Sep;17 (43):1–253.
  7. Okada S, Morimoto T, Ogawa H et al. Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk. Circ J. 2013;77 (12):3023–8.
  8. Pignone M, Alberts MJ, Colwell JA et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Diabetes Care. 2010 Jun;33 (6):1395–402.
  9. Kolber M, Sharif N, Marceau R, Szafran O. Family practice patients’ use of acetylsalicylic acid for cardiovascular disease prevention. Can Fam Physician. 2013 Jan;59 (1):55–61.
  10. Hissett J, Folks B, Coombs L et al. Effects of changing guidelines on prescribing aspirin for primary prevention of cardiovascular events. J Am Board Fam Med. 2014 Jan-Feb;27 (1):78–86.
  11. Yaguchi T, Yokoyama H, Nakamura H et al. Evaluation of the development of gastroduodenal lesions in patients treated with low-dose aspirin or non-steroidal anti-inflammatory drugs. Yakugaku Zasshi. 2011;131 (7):1085–94.
  12. Ng W, Wong WM, Chen WH et al. Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease.World J Gastroenterol. 2006 May 14;12 (18):2923–7.
  13. Gellatly RM, Ackman ML. Single antiplatelet therapy for patients with previous gastrointestinal bleeds. Ann Pharmacother. 2008 Jun;42 (6):836–40.
  14. Tsai TJ, Lai KH, Hsu PI et al. Upper gastrointestinal lesions in patients receiving clopidogrel anti-platelet therapy. J Formos Med Assoc. 2012 Dec;111 (12):705–10.
  15. Nonsteroidal anti-inflammatory drugs: add an anti-ulcer drug for patients at high risk only. Always limit the dose and duration of treatment with NSAIDs. Prescrire Int. 2011 Sep;20 (119):216–9.
  16. Sakamoto C, Sugano K, Ota S. Case-control study on the association of upper gastrointestinal bleeding and nonsteroidal anti-inflammatory drugs in Japan.Eur J Clin Pharmacol. 2006 Sep;62 (9):765–72.
  17. Uemura N, Sugano K, Hiraishi H et al, MAGIC Study Group. Risk factor profiles, drug usage, and prevalence of aspirin-associated gastroduodenal injuries among high-risk cardiovascular Japanese patients: the results from the MAGIC study. J Gastroenterol. 2014 May;49 (5):814–24.
  18. Weil J, Colin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ. 1995 Apr 1;310 (6983):827–30.
  19. Yu J, Mehran R, Dangas GD et al. Safety and efficacy of high-versus low-dose aspirin after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv. 2012 Dec;5 (12):1231–8.
  20. Henry P, Vermillet A, Boval B, et al. 24‑hour time-dependent aspirin efficacy in patients with stable coronary artery disease. Thromb Haemost. 2011 Feb;105 (2):336–44.
  21. Peace A, McCall M, Tedesco T et al. The role of weight and enteric coating on aspirin response in cardiovascular patients. J Thromb Haemost. 2010 Oct;8 (10):2323–5.
  22. Endo H, Sakai E, Higurashi T et al. Differences in the severity of small bowel mucosal injury based on the type of aspirin as evaluated by capsule endoscopy.Dig Liver Dis. 2012 Oct;44 (10):833–8.
  23. Hirata Y, Kataoka H, Shimura T et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: buffered aspirin versus enteric-coated aspirin. Scand J Gastroenterol. 2011 Jul;46 (7-8):803–9.
  24. Jost V, Kuhn I, Rogalla K et al. Gastric potential difference measurement as a quantification of gastrointestinal tolerability comparing a buffered acetylsalicylic acid formulation versus plain acetylsalicylic acid. Arzneimittelforschung. 1992 May;42 (5):650–3.
  25. Rogalla K, Lange R, Panijel M. Gastric tolerance of single dose unbuffered and buffered acetylsalicylic acid: a randomized compa­rative endoscopic study in 24 volunteers. Int J Clin Pharmacol Res. 1992;12 (3):133–8.
  26. Viganò G, Garagiola U, Gaspari F et al. Pharmacokinetic study of a new oral buffered acetylsalicylic acid (ASA) formulation in comparison with plain ASA in healthy volunteers. Int J Clin Pharmacol Res. 1991;11 (3):129–35.
  27. García Rodríguez LA1, Hernández-Díaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: syste­matic review of epidemiologic studies. Br J Clin Pharmacol. 2001 Nov;52 (5):563–71.
  28. Баркаган З. С., Котовщикова Е. Ф. Сравнительный анализ основных и побочных эффектов различных форм ацетилсалициловой кислоты. Клиническая фармакология и терапия. 2004;13 (3):
  29. Яковенко Э. П., Краснолобова Л. П., Яковенко А. В. и др. Влия­ние препаратов АСК на морфофункциональное состояние слизистой оболочки желудка у кардиологических пациентов пожилого возраста. Сердце. 2013;12 (3):145–150.
  30. Taha AS, McCloskey C, Prasad R, Bezlyak V. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet. 2009 Jul 11;374 (9684):119–25.
  31. Miyamoto M, Haruma K, Okamoto T et al. Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan. J Gastroenterol Hepatol. 2012 Feb;27 (2):372–7.
  32. Saini SD, Fendrick AM, Scheiman JM. Cost-effectiveness analysis: cardiovascular benefits of proton pump inhibitor co-therapy in patients using aspirin for secondary prevention. Aliment Pharmacol Ther. 2011 Jul;34 (2):243–51.
  33. Chan FK, Ching JY, Suen BY et al. Effects of Helicobacter pylori infection on long-term risk of peptic ulcer bleeding in low-dose aspirin users. Gastroenterology. 2013 Mar;144 (3):528–35.
Minushkina L. O. Safety issues in using acetylsalicylic acid drugs for prevention of cardiovascular complications. Russian Heart Journal. 2014;77 (3):173–178

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