salicylates and Pulmonary-Embolism

Triflusal is an antiplatelet agent structurally related to the salicylate group of compounds, but it is not derived from aspirin (acetylsalicylic acid). Platelet antiaggregant properties of triflusal and its active 3-hydroxy-4-trifluoro-methylbenzoic acid metabolite are primarily mediated by specific inhibition of platelet arachidonic acid metabolism. Triflusal, compared with placebo for 6 months, significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. In patients with peripheral arteriopathy, total and pain free walking distances were markedly improved in triflusal compared with placebo recipients. The cumulative event rate for stroke, ischemic cardiopathy and vascular death was lower, but not significantly different, in patients with atherothrombotic stroke who received triflusal than in aspirin recipients. Differences were significant, and favoured triflusal, in a subgroup of patients with > 70% carotid stenosis. Prophylaxis with triflusal for 6 months after aortocoronary vein grafting reduced the number of new distal anastomosis occlusions and the graft attrition rate more than aspirin or placebo. The incidence of deep vein thrombosis or pulmonary embolism in more than 500 patients undergoing hip surgery was similar for these 3 treatments. The amount of blood transfused was significantly reduced in triflusal compared with aspirin recipients who underwent hip surgery. Risk of haemorrhage was also reduced in ischemic stroke patients receiving triflusal versus aspirin.

Topics: Adult; Angina Pectoris; Animals; Aspirin; Carotid Stenosis; Humans; In Vitro Techniques; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Postoperative Complications; Pulmonary Embolism; Randomized Controlled Trials as Topic; Salicylates; Thrombophlebitis

Topics: Asthma; Asthma, Exercise-Induced; Bronchitis; Cough; Diagnosis, Differential; Heart Failure; Humans; Occupational Diseases; Peak Expiratory Flow Rate; Pruritus; Pulmonary Embolism; Radiography, Thoracic; Respiratory Sounds; Salicylates

Pulmonary embolism (PE) is a serious complication following hip surgery. Trials of antiplatelet thromboprophylaxis indicated a substantial reduction in PE rate, and we prospectively studied the effect of a combination of low-dose heparin and two different antiplatelets. Furthermore, our experience in previous studies suggested that platelet count (PC) levels could be useful to reliably suspect PE at a very early stage, and we prospectively tried to confirm our previous findings. Ours is a prospective study in 459 consecutive patients operated on because of hip fracture (265) or elective hip replacement (194), aimed to determine: 1) whether the benefits of antiplatelets plus heparin on PE outweigh the risks; 2) to assess the clinical usefulness of PC monitoring in these patients, so as to confirm whether PE could be recognized early. It was a prospective, randomized, double-blind study. All patients received unfractioned heparin (7500 IU sc twice daily, starting 2 h before operation). In addition, they received aspirin (200 mg thrice daily, with meals), Triflusal (300 mg thrice daily, with meals), or placebo. Real time B-mode ultrasonography (US) was performed on all patients on the 8-9th day after surgery. Venography was performed in patients with normal US, if clinical symptoms suggested venous thrombosis. Twelve out of the 459 patients (2.6%) had to discontinue prophylaxis, because of major bleeding (6 patients), or gastric intolerance (6 patients). There were no significant differences between groups in either deep vein thrombosis (26 patients (18%) with aspirin, 18 (12%) with Triflusal, 26 (17%) with placebo), or PE development (7 patients (5%) with aspirin, 3 (2%) with Triflusal, 8 (5%) taking placebo).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Aspirin; Double-Blind Method; Drug Therapy, Combination; Female; Hemorrhage; Heparin; Hip Fractures; Hip Prosthesis; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Count; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Radionuclide Imaging; Salicylates; Thrombophlebitis; Treatment Outcome; Ultrasonography; Vomiting

Topics: Animals; Guinea Pigs; Heart; Heart Failure; In Vitro Techniques; Indomethacin; Lung; Platelet Aggregation; Pulmonary Embolism; Salicylates

Topics: Animals; Heparin; Humans; Prognosis; Pulmonary Embolism; Radionuclide Imaging; Salicylates; Thrombophlebitis; Time Factors