salicylates and Thromboembolism

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

Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. Up to date, however, results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study was to compare the efficacy and safety of triflusal (an antiplatelet agent) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis.. In this prospective, multicentric, randomized, open pilot trial, patients were assigned to treatment with triflusal (600mg/d) or acenocoumarol (target INR 2.0-3.0). Study medication was started 24-48h after valve replacement with a bioprosthesis, and continued for 3 months. Four follow-up visits were scheduled: baseline, and at 1, 3 and 6 months thereafter. The primary end-point was a composite of the rate of thromboembolism, severe hemorrhage and valve-related mortality.. A total of 193 patients were included (97 received triflusal and 96 acenocoumarol), with a mean age of 72.5 years. Half were men. Aortic valve replacement was performed in 181 patients (93.8%), mitral valve replacement in 10 patients (5.2%) and double valve replacement in 2 (1.0%). Hospital mortality was 11 (5.7%). Primary outcome was recorded in 9 patients with triflusal (9.4%) and in 10 patients with acenocoumarol (11%). There were nine episodes (4.7%) of thromboembolism, six in the triflusal group and three in the acenocoumarol group, and three episodes of permanent neurological deficits, one in the triflusal group and two in the acenocoumarol group. Severe hemorrhage: nine episodes, six in the acenocoumarol group and three in the triflusal group. None of the observed differences in efficacy were statistically significant. Regarding safety, three patients in triflusal group reported at least one hemorrhage, compared to 10 in acenocoumarol group (P=0.048).. There were no significant differences in efficacy between both groups, however, triflusal showed a significantly lower incidence of bleeding episodes.

Topics: Acenocoumarol; Aged; Anticoagulants; Bioprosthesis; Epidemiologic Methods; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Platelet Aggregation Inhibitors; Postoperative Complications; Postoperative Hemorrhage; Salicylates; Thromboembolism

Aspirin has been shown to be beneficial in the prophylaxis of arterial thromboembolic disease. The rationale for its use as an antithrombotic drug lies in its inhibition of thromboxane A2-dependent platelet function. However, the effect of aspirin on coagulation and fibrinolysis during chronic therapy has not been studied. We have measured a range of haemostatic and platelet functions in 49 patients with transient ischaemic attacks randomly allocated to aspirin 300 mg a day, aspirin 1,200 mg a day or placebo. All had been taking their allocated treatment for between 9 months and 4 years prior to investigation. Bleeding time was prolonged, serum thromboxane diminished and platelet aggregation to arachidonic acid but not ADP was abolished by both 300 mg and 1,200 mg aspirin, in a non-dose dependent fashion. Serum salicylate increased with the dose of aspirin ingested. No effect was seen with either dose of aspirin on urinary thromboxane and 6-keto-PGF1 alpha excretion, or on coagulation. Patients taking 1,200 mg aspirin a day had a lower haemoglobin and packed cell volume, lower resting fibrinopeptide A concentration and lower basal plasminogen activator activity than those on placebo. Response to venous occlusion was normal in all groups. The results suggest 300 mg and 1,200 mg aspirin have an equivalent platelet inhibitory effect but 1,200 mg aspirin causes greater gastro-intestinal blood loss.

Topics: Aged; Aged, 80 and over; Aspirin; Bleeding Time; Blood Coagulation; Dose-Response Relationship, Drug; Female; Fibrinolysis; Fibrinopeptide A; Humans; Male; Middle Aged; Placebos; Plasminogen Activators; Platelet Aggregation; Platelet Aggregation Inhibitors; Salicylates; Thromboembolism; Thromboxane B2; Time Factors

In a double-blind trial of tranexamic acid in massive upper gastrointestinal haemorrhage, 76 patients were treated with the active drug and 73 patients with placebo. The doses were 1 g intravenously six times daily for a maximum of 3 days, followed by 1.5 g orally four times daily for a maximum of 4 days. The treatment group and the placebo group were comparable with respect to mean age, diagnoses and laboratory tests but differed slightly with respect to sex and alcohol consumption. The transfusion requirement in the treatment group was less than in the placebo group during the first days after admission, the difference being significant on the second day after admission. Ten patients in the treatment group and 18 patients in the placebo group were operated on. Eleven patients in the treatment group and 12 patients in the placebo group died. In the tranexamic-acid-treated group fewer operations were performed and significantly less blood was needed. It therefore seems highly likely that tranexamic acid has a beneficial effect, although small.

Topics: Aged; Alcohol Drinking; Blood Transfusion; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gastrointestinal Hemorrhage; Hemoglobins; Humans; Male; Middle Aged; Placebos; Prothrombin; Random Allocation; Salicylates; Thromboembolism; Tranexamic Acid

Topics: Aged; Humans; Male; Photosensitivity Disorders; Salicylates; Thromboembolism; Urticaria

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

To evaluate the adequacy to thromboembolic disease prophylaxis protocol in patients with heart disease.. Cross-sectional study.. Patients older than 14 years affected of heart disease in a semi-urban health primary-care clinic with a population of 10,610 persons and 5582 clinical records.. Data about age, sex, cardiovascular risk factors, heart disease, prophylactic treatment and its adequacy to the protocol of the "thromboembolic disease commission" of the reference hospital were analysed.. Age 67 +/- 13 years (mean +/- SD). Cardiovascular risk factors: hypertension 40%, diabetes 33%, dyslipemia 15%, smoking 21%. Heart disease: ischemic cardiopathy 48%, atrial fibrillation 15%, valvulopathy 19%, dilated myocardiopathy 4% and other 14%. In 20% of cases had two different affections (80% with atrial fibrillation). Prophylactic therapy: 52% of patients were under prophylactic treatment (35% antiaggregation, 18% anticoagulation). Among antiaggregants, drugs used were acetylsalicylic acid 73.5%, triflusal 14.7%, dipyridamole, 8.8% and ticlopidine 3%. In 53% of people without prophylactic treatment antiaggregation criteria were present. 15% of patient under antiaggregation therapy did not meet antiaggregation criteria, and 6% fulfilled anticoagulation criteria. 67% treatments accorded the reference protocol, without significant differences between kind of heart disease or sex. The only statistically significant difference was found in age: 46% of patients older than 80 year were correctly treated, in front 75% adequacy in younger people.. Prophylactic antithrombotic therapy was according the reference protocol in 67% of cases. In older patients, with greater risk of thromboembolic disease, the adequacy is worse.

Topics: Age Factors; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Cross-Sectional Studies; Dipyridamole; Female; Heart Diseases; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Risk Factors; Salicylates; Sex Factors; Thromboembolism; Ticlopidine

The purpose of this study was to investigate the incidence, outcome and prevention of thrombo-embolism in children with dilated cardiomyopathy. From 130 patients with dilated cardiomyopathy, 17 (14%) showed evidence of thrombo-embolism. Seven had initial cardiac thrombus, 7 exhibited initial embolus and in 3 thrombo-embolism was only diagnosed at autopsy. All 17 patients showed seriously impaired systolic function of the left ventricle with fractional shortening (FS) of 10 +/- 3%, range 5%-17%, as compared to those without thrombo-embolism with FS of 17% +/- 6%, range 5%-26% (P < 0.0001). Seven patients were treated with oral anticoagulants once thrombo-embolism had been diagnosed; one of them experienced a further embolic event as opposed to three out of four patients not treated with anticoagulants.. All children with dilated cardiomyopathy and fractional shortening below 20% should be treated with prophylactic anticoagulative agents.

Topics: Adolescent; Anticoagulants; Cardiomyopathy, Dilated; Child; Child, Preschool; Humans; Incidence; Infant; Retrospective Studies; Salicylates; Salicylic Acid; Switzerland; Thromboembolism; Treatment Outcome; Ultrasonography

Topics: Humans; Platelet Aggregation; Salicylates; Thromboembolism; Vascular Diseases

In five patients with obstruction of the retinal arteries, three with emboli, the circulation was reestablished by bulbus massage, intravenous administered acetazolamide and theophylamine. The patients were further treated with salicyclic acid for six months. An improvement of vision was obtained with maintained over a 2-year period. The basis of the present treatment occlusive arterial disorders in the retinal is discussed.

Topics: Acetazolamide; Aged; Aminophylline; Female; Fluorescein Angiography; Humans; Male; Massage; Middle Aged; Retinal Artery; Salicylates; Thromboembolism; Thrombosis

Topics: Adult; Humans; Kinetics; Middle Aged; Salicylates; Thromboembolism