salicylates and Atrial-Fibrillation

Triflusal (Aflen, Disgren, Tecnosal, Triflux) is a novel platelet antiaggregant with structural similarities to salicylates, but which is not derived from aspirin. It has similar efficacy to aspirin in patients with cerebral or myocardial infarction, but has a reduced risk of haemorrhagic complications. In addition, triflusal plus moderate-intensity anticoagulation has demonstrated efficacy when used as thromboprophylaxis in atrial fibrillation. As such, triflusal has a role in the primary prevention of cerebrovascular events in atrial fibrillation, and for the secondary prevention of cerebral and myocardial infarction, primarily as an alternative to aspirin in patients for whom aspirin is unsuitable.

Topics: Atrial Fibrillation; Cardiovascular Diseases; Cerebral Infarction; Drug Interactions; Humans; Meta-Analysis as Topic; Myocardial Infarction; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Salicylates; Thromboembolism

This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis.. Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated.. We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age >60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism.. Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate- (hazard ratio [HR] 0.33 [95% confidence interval (CI)0.12 to 0.91]; p = 0.02) and the high-risk group (HR 0.51 [95% CI 0.27 to 0.96]; p = 0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy.. The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Cause of Death; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embolism; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Intracranial Embolism; Male; Middle Aged; Mitral Valve Stenosis; Platelet Aggregation Inhibitors; Proportional Hazards Models; Salicylates; Survival Analysis; Treatment Outcome

Few trials have studied platelet activity during oral anticoagulation and all show a tendency for platelet aggregation to increase. This adverse effect has also been shown in some patients treated with unfractionated heparin, the so-called white clot syndrome. We studied platelet aggregation in patients with atrial fibrillation enrolled in the NASPEAF study and receiving antiaggregant, anticoagulant and both treatments.. 15 healthy control subjects (group C) and 99 patients were enrolled, the latter receiving 4 different antithrombotic regimens for platelet aggregation: group 1, 600 mg of the antiplatelet drug triflusal; group 2, anticoagulation for an INR of 2-3; and both treatments with 2 different levels of anticoagulation, mean INR of 1.85 (group 3) and of 2.15 (group 4). The same amounts of the agonists ADP, arachidonic acid and collagen were used in all tests. For statistical analysis we used the interval in min, from the addition of the agonist to the beginning of aggregation and the % of aggregation at 5 and 8 min.. After arachidonic acid was given, the interval to the beginning of aggregation was shorter in group 2 than in group C: 0.6 +/- 0.21 and 1.1 +/- 1.2, and in both was significantly shorter than in the other three receiving antiplatelet drugs alone: group 1 = 1.58 +/- 1.4 or combined with anticoagulants: group 3 = 1.7 +/- 1.7 and group 4 = 2.4 +/- 2.1. The % of aggregation at 5 min, in groups C, 2, 1, 3 and 4 was respectively 48 +/- 24, 43.2 +/- 19, 29.6 +/- 17, 34.8 +/- 22 and 23.2 +/- 22.5. The data showed significantly increased platelet activity in groups C and 2 compared to groups 1, 3 and 4. Group 3 with a low anticoagulation level (mean INR = 1.85) showed a tendency to greater platelet activity than group 1 and 4 with p value = 0.08.. The antiplatelet drug triflusal alone or combined with a therapeutic level of anticoagulation effectively reduces platelet aggregation and is not influenced by anticoagulant treatment. A low level of anticoagulation (INR < 2) shows a tendency to increase platelet activity.

Topics: Acenocoumarol; Adenosine Diphosphate; Aged; Analysis of Variance; Anticoagulants; Arachidonic Acid; Atrial Fibrillation; Blood Platelets; Collagen; Embolism; Female; Humans; Male; Platelet Aggregation; Platelet Aggregation Inhibitors; Salicylates; Time Factors

The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA. We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0-3) and high thrombus burden (HTB; TIMI 4 and 5).. The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA. The CHA. HINTERGRUND: Die Verschlussrate für V.-saphena-Transplantate (SVG) innerhalb des ersten Jahres nach der Bypass-Operation liegt bei 15%. Zur Vorhersage des Risikos thromboembolischer Ereignisse bei Patienten mit nichtvalvulärem Vorhofflimmern wird der CHA. Retrospektiv wurden 221 Patienten untersucht, die wegen AMI stationär aufgenommen wurden und bei denen zwischen 2012 und 2018 am Department of Cardiology im Turkiye Yuksek Ihtisas Education and Research Hospital eine SVG-PCI durchgeführt wurde. Die Studienpopulation wurde entsprechend ihrem Thrombusgrad gemäß Thrombolysis in Myocardial Infarction (TIMI) in 2 Gruppen unterteilt: niedrige Thrombuslast (LTB; TIMI 0–3) und hohe Thrombuslast (HTB; TIMI 4 und 5).. In die Studie wurden 221 Patienten mit einem Durchschnittsalter von 63,3 ± 6,7 Jahren aufgenommen. Patienten mit HTB wiesen signifikant höhere CHA. Der CHA

Topics: Aged; Atrial Fibrillation; Humans; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Salicylates; Thrombosis

In the NASPEAF (National Study for Prevention of Embolism in Atrial Fibrillation) trial, combination therapy with an anticoagulant and an antiplatelet was more effective than anticoagulation alone in patients with atrial fibrillation. We report long-term follow-up in these patients, including prospective evaluation of different antiplatelet therapies.. This analysis included 574 atrial fibrillation patients. Standard anticoagulation (international normalized ratio [INR] 2.0-3.0) was used as control therapy to compare with anticoagulation (INR 1.9-2.5) plus either triflusal at 600 mg/day, triflusal at 300 mg/day or aspirin at 100 mg/day. The primary endpoint was ischemic or hemorrhagic stroke, a systemic or coronary ischemic event, or cardiovascular death. The mean follow-up was 4.92 years.. Long-term follow-up confirmed that combination therapy with an anticoagulant plus triflusal at 600 mg/day gave significantly better results than anticoagulation alone (hazard ratio [HR]=0.33; 95% confidence interval [CI], 0.14-0.80; P=.014). There was a significantly higher incidence of ischemic events with triflusal at 300 mg/day (P=.031) and of severe bleeding events with aspirin at 100 mg/day (P=.008). The mean INR was similar in the three combination therapy groups. The incidence of severe nongastric bleeding during combination therapy with triflusal was very low (0.3% of patients/year).. Long-term follow-up confirmed that combination antithrombotic therapy with triflusal at 600 mg/day gave significantly better results than anticoagulant monotherapy. The results obtained with combination therapy with triflusal at 300 mg/day and with aspirin at 100 mg/day should be considered provisional because the treatment groups were small and treatment was not randomly assigned.

Topics: Aged; Aspirin; Atrial Fibrillation; Female; Follow-Up Studies; Humans; Male; Platelet Aggregation Inhibitors; Prospective Studies; Salicylates; Time Factors

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Drug Therapy, Combination; Humans; Platelet Aggregation Inhibitors; Salicylates; Thromboembolism; Treatment Outcome; Warfarin

Topics: Aged; Atrial Fibrillation; Death, Sudden, Cardiac; Geriatrics; Humans; Platelet Aggregation Inhibitors; Salicylates

Topics: Acenocoumarol; Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; International Normalized Ratio; Male; Middle Aged; Mitral Valve Stenosis; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Salicylates; Warfarin