Acetylsalicylic acid – the role in prevention and treatment cardiovascular diseases Review article
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Published:
Apr 13, 2010
Keywords:
acetylsalicylic acid, antiplatelet therapy, cardiovascular diseases
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Abstract
Acetylsalicylic acid (ASA) is a well established antithrombotic drug. The basis of the antithrombotic effect of ASA is the irreversible inhibition of platelet cyclooxygenase, a key enzyme in prostaglandin metabolism. As a consequence, platelets lose their capacity to synthesize tromboxane A2 which induces platelet aggregation and has vasoconstrictive properties. Acetylsalicylic acid inhibits platelet activation and reduces thrombotic complications in patients at risk of coronary artery disease, myocardial infarction and stroke. The antithrombotic effect of ASA has been extensively clinically studied and documented. Large epidemiological studies and comprehensive meta-analyses have shown that ASA significantly reduces the risk of thromboembolic vascular events. Aspirin resistance has been reported in patients with cardiovascular, cerebrovascular and peripheral vascular disease. Strategies are needed to identify patients at risk for aspirin resistance who might benefit from alternative or dual antiplatelet therapy.
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Gierlak, W., & Kuch , M. (2010). Acetylsalicylic acid – the role in prevention and treatment cardiovascular diseases. Medycyna Faktow (J EBM), 3(1(6), 78-87. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2618
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References
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29. Welsh P.A. et al.: A prospective, blinded determination of the natural history of aspiryn resistance among stable patients with cardiovascular disease. J. Am. Coll. Cardiol. 2003; 41: 961-5.
30. Cambria-Kiely J.A., Gandhi P.J.: Possible mechanisms of aspiryn resistance. J. Thromb. Thrombolysis 2002; 13: 49-56.
31. Cambria-Kiely J.A., Gandhi P.J.: Aspiryn resistance and genetic polymorphisms. J. Thromb. Thrombolysis 2002; 14: 51-8.
32. Verstuyft C.: Personalized Medicine and Antiplatelet Therapy: Ready for Prime Time? European Heart Journal 2009; 30(16): 1943-1963.
33. Gasparyan A.Y. et al.: The Role of Aspirin in Cardiovascular Prevention. JACC 2008; 51(19): 1829-1843.
2. Cannon C.P. et al.: Current use of aspirin and antithrombotic agents in the United States among outpatients with atherothrombotic disease (from the Reduction of Atherothrombosis for Continued Health [REACH] Registry). Am. J. Cardiol. 2010; 105: 445-452.
3. Patrono C.: Aspirin as an antiplateled drug. N. Engl. J. Med. 1994; 330: 1287.
4. ISIS-2 Collaborative Group: Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1998; 349: II.
5. The RISC Group: Risc of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827.
6. Juul-Moller S. et al.: Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Study Investigators. Lancet 1992; 340(8833): 145-153.
7. Antiplateled Tralists Collaboration. Collaborative overview of randomised trias of antiplateled theraphy. Br. Med. J. 1994, 308, 81.
8. Hirs J.: Aspirin and other plateled-active drugs. The relationship between dose, effectiveness and side effects. Chest 1992; 102(supl.): 327.
9. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-segment Elevation. The Clopidogrel in Unstable Angina to Prevent Recurrent Events ( CURE) Trial Investigators. N. Engl. J. Med. 2001; 345: 494-502.
10. Steering Committee of the Physicians Health Study Research Group: Final report on aspirin component of ongoing Physicians Health Study. N. Engl. J. Med. 1989; 321: 129.
11. Kurth T. et al.: Inhibition of clinical benefits of aspirin on first myocardial infarction by nonsteroidal anti-inflamatory drugs. Circulation 2003; 108: 1191.
12. Peto R., Gray R., Collins R. et al.: Randomised trial of profilactic daily aspirin in British male doctors (British Doctor’s Trial). Br. Med. J. 1988 Jan 30; 296(6618): 313-6.
13. Eidelman R.S., Hebert P.R., Weisman S.M. et al.: An update on aspirin in the primary prevention of cardiovascular disease. Arch. Intern. Med. 2003; 163: 2006-2010.
14. Lauer M.S.: Aspirin for primary prevention of coronary events. N. Engl. J. Med. 2002; 346: 1468-1474.
15. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. EHJ 2007; 28: 2375-2414.
16. American Diabetes Association: Standards of medical care in diabetes – 2006. Diabetes Care 2006; 29(supl. 1): S4-S42.
17. American Diabetes Association. Standards of medical care in diabetes – 2010. Diabetes Care 2010; 33(supl. 1).
18. Ridker P.M., Cook N.R., Lee J.M. et al.: A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women (Women’s Health Study). N. Engl. J. Med. 2005 Mar 7; 352: 1293-1304.
19. Berger J.S., Rancaglioni M.C., Avanzini F. et al.: Aspiryn for the primary prevention of cardiovascular events In women and men: a sex-specific metaanalysis of randomized controlled trails. JAMA 2006 Jan 18; 295(3): 306-13.
20. Zimmermann N. et al.: Aspirin resistance after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2001; 121: 982-4.
21. Teal P.A. et al.: Recent clinical trial results with antiplatelet theraphy: implication in stroke prevention. Cerebrovasc. Dis. 2004; 17(supl. 3): 6-10.
22. The ESPRIT study group. Aspirin plus dipiridamol versus aspirin alone after cerebral ischaemia of arterial origin. Lancet 2006; 367: 1665-1673.
23. van Latum J.C., Koudstaal P.J., Venables G.S., van Gijn J., Kappelle L.J., Algra A. (for the European Atrial Fibrillation Trial (EAFT) Study Group): Predictors of Major Vascular Events in Patients With a Transient Ischemic Attack or Minor Ischemic Stroke and With Nonrheumatic Atrial Fibrillation. Stroke 1995; 5(26): 801-6.
24. Stroke Prevention in Atrial Fibrillation investigators: Warfarin versus aspirin for prevention of tromboembolism in Atrial Fibrillation II study. Lancet 1994; 343: 687.
25. Fuster V. et al.: Management of atrial fibrillation. Eur. Heart J. 2001; 22: 1852-1923.
26. The ACTIVE investigators: Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N. Engl. J. Med. 2009 May 14; 360(20): 2066-78.
27. Howard P.A.: Aspirin resistance. Ann. Pharmacother. 2002; 36: 1620-4.
28. The HOPE Study Investigators. The HOPE (Heart Outcomes Prevention Evaluation) Study: The design of a large, simple randomized trial of an angiotensin converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. Can. J. Cardiol. 1996; 12: 127-137.
29. Welsh P.A. et al.: A prospective, blinded determination of the natural history of aspiryn resistance among stable patients with cardiovascular disease. J. Am. Coll. Cardiol. 2003; 41: 961-5.
30. Cambria-Kiely J.A., Gandhi P.J.: Possible mechanisms of aspiryn resistance. J. Thromb. Thrombolysis 2002; 13: 49-56.
31. Cambria-Kiely J.A., Gandhi P.J.: Aspiryn resistance and genetic polymorphisms. J. Thromb. Thrombolysis 2002; 14: 51-8.
32. Verstuyft C.: Personalized Medicine and Antiplatelet Therapy: Ready for Prime Time? European Heart Journal 2009; 30(16): 1943-1963.
33. Gasparyan A.Y. et al.: The Role of Aspirin in Cardiovascular Prevention. JACC 2008; 51(19): 1829-1843.