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ESC Congress 2003: Blood thinners like aspirin may not be equally effective for everybody to prevent heart attack and stroke
September 01, 2003IMPORTANT: This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology
ESC Congress 2003: Clot-busters - do they work for all?
Atherosclerosis is a slow, progressive disease accompanied with sudden dramatic episodes of blood clot formation within arteries. Arteries occluded instantly by clots can not provide enough oxigenated blood to tissues of the heart, brain, or legs, therefore these tissues die. The clinical symptoms related to these events are myocardial infarction, stroke or acute limb ischaemia, respectively. Generation of arterial blood clots is initiated by activated blood platelets. The most common drug that objects the platelet's ability to form blood clot is aspirin, which is a relatively weak, but very useful blood thinner.
Doctors have been ordering aspirin since the sixties to prevent the occurence of heart attack, myocardial infarction, stroke. Aspirin is a cheap and clearly effective drug. It can reduce the risk of vascular catastrophes listed above by at least 25 percent (as an average).
There is no drug with a completely equal effect in every human being. Individuals are different, and - probably even more importantly - the extent of their disease is also different. We, cardiologists learned that in case of a more severe clinical situation, when the inner layer of blood vessels is seriously injured we have to use stronger or combined blood thinners in order to avoid occlusive blood clotting.
These particularly serious situations include chest pain threatening with a heart attack; angioplasty, when doctors actively injure the vessel by dilating its narrowing, or when they buttress the artery with a little metal tube called stent, to keep it open.
The most classical blood thinner is coumadine. When the patient takes coumadine, doctors (must) perform regular blood tests, called INR measurements to avoid bleeding or blood clots. Interestingly enough, we do not test the effect of the most widely used blood thinner, aspirin.
It has been believed, that aspirin therapy does not need any laboratory test to follow. However, clinical evidence appeared indicating that in some people aspirin might not inhibit blood platelets as effectively as in others. This phenomenon is called aspirin resistance. Obviously, it is likely that in these patients sudden occlusive blood clots can not be prevented by aspirin and these patients would not have benefit from taking the ineffective drug further.
Studying 1000 patients from HOPE trial, Dr Eikelboom and others from Professor Yusuf's group elegantly proved the clinical importance of aspirin resistance. Aspirin halts the production of a signaling molecule called thromboxane A2, which is one of the most important chemicals, forcing platelets to stick together and to start forming a blood clot.
Thromboxane A2 is degraded in the body to thromboxane B2, and the latter can be detected in the patients' urine. Aspirin takers, who still urinate a high amount of thromboxan B2 - an indicator of the maintained high thromboxane A2 production - had to face a 3,5 fold risk of cardiovascular death compared to others who had low urine thromboxane B2 concentration.
As a result, we can state that in some people aspirin can not produce as pronounced inhibitory effect as in others. These patients have a higher chance to die from heart attack or stroke and may need alternative, stronger blood thinning treatment. Measuring urine thromboxane B2 level to identify these „drug-resistant" patients is a fairly complicated and expensive method, and is largery confined to research centers. Finding a simple and cheap alternative might be very useful in treating patients with atherosclerosis.
Therefore our team has tried to adapt a simple blood test, called platelet aggregation, to screen aspirin taking patients. Ten centers (invasive cardiovascular university centers, stroke departments, county hospitals) applied the same laboratory method using the same simple instrument measuring platelet reactivity in response to different platelet activators.
First, we collected 150 patients, survivors of a myocardial infarction or stroke who were not treated with any blood thinner and served as our control group. Then we measured the platelet reactivity of the next 2215 patients, who were taking aspirin at a dose of 100-125 mg daily. Aspirin-treated patients, whose platelets remained active and responded to the agonists like not-treated ones, were considered as aspirin resistant.
According to our measurements, the chance of being aspirin resistant among patients taking aspirin for secondary prevention after heart attack or stroke is 26,9 % in Hungary.
The clinical importance of this observation has to be determined by further research. Nevertheless, we hope that we can identify those patients by this method, in whom alternative or combination blood thinner treatment may be beneficial.
Robert Gabor Kiss M.D. Ph.D.
National Center for Health Services, Budapest
Hungary
European Society of Cardiology (ESC)
Doctors have been ordering aspirin since the sixties to prevent the occurence of heart attack, myocardial infarction, stroke. Aspirin is a cheap and clearly effective drug. It can reduce the risk of vascular catastrophes listed above by at least 25 percent (as an average).
There is no drug with a completely equal effect in every human being. Individuals are different, and - probably even more importantly - the extent of their disease is also different. We, cardiologists learned that in case of a more severe clinical situation, when the inner layer of blood vessels is seriously injured we have to use stronger or combined blood thinners in order to avoid occlusive blood clotting.
These particularly serious situations include chest pain threatening with a heart attack; angioplasty, when doctors actively injure the vessel by dilating its narrowing, or when they buttress the artery with a little metal tube called stent, to keep it open.
The most classical blood thinner is coumadine. When the patient takes coumadine, doctors (must) perform regular blood tests, called INR measurements to avoid bleeding or blood clots. Interestingly enough, we do not test the effect of the most widely used blood thinner, aspirin.
It has been believed, that aspirin therapy does not need any laboratory test to follow. However, clinical evidence appeared indicating that in some people aspirin might not inhibit blood platelets as effectively as in others. This phenomenon is called aspirin resistance. Obviously, it is likely that in these patients sudden occlusive blood clots can not be prevented by aspirin and these patients would not have benefit from taking the ineffective drug further.
Studying 1000 patients from HOPE trial, Dr Eikelboom and others from Professor Yusuf's group elegantly proved the clinical importance of aspirin resistance. Aspirin halts the production of a signaling molecule called thromboxane A2, which is one of the most important chemicals, forcing platelets to stick together and to start forming a blood clot.
Thromboxane A2 is degraded in the body to thromboxane B2, and the latter can be detected in the patients' urine. Aspirin takers, who still urinate a high amount of thromboxan B2 - an indicator of the maintained high thromboxane A2 production - had to face a 3,5 fold risk of cardiovascular death compared to others who had low urine thromboxane B2 concentration.
As a result, we can state that in some people aspirin can not produce as pronounced inhibitory effect as in others. These patients have a higher chance to die from heart attack or stroke and may need alternative, stronger blood thinning treatment. Measuring urine thromboxane B2 level to identify these „drug-resistant" patients is a fairly complicated and expensive method, and is largery confined to research centers. Finding a simple and cheap alternative might be very useful in treating patients with atherosclerosis.
Therefore our team has tried to adapt a simple blood test, called platelet aggregation, to screen aspirin taking patients. Ten centers (invasive cardiovascular university centers, stroke departments, county hospitals) applied the same laboratory method using the same simple instrument measuring platelet reactivity in response to different platelet activators.
First, we collected 150 patients, survivors of a myocardial infarction or stroke who were not treated with any blood thinner and served as our control group. Then we measured the platelet reactivity of the next 2215 patients, who were taking aspirin at a dose of 100-125 mg daily. Aspirin-treated patients, whose platelets remained active and responded to the agonists like not-treated ones, were considered as aspirin resistant.
According to our measurements, the chance of being aspirin resistant among patients taking aspirin for secondary prevention after heart attack or stroke is 26,9 % in Hungary.
The clinical importance of this observation has to be determined by further research. Nevertheless, we hope that we can identify those patients by this method, in whom alternative or combination blood thinner treatment may be beneficial.
Robert Gabor Kiss M.D. Ph.D.
National Center for Health Services, Budapest
Hungary
European Society of Cardiology (ESC)
Aspirin Current Events and Aspirin News RSSEarly end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Common Pain Relievers May Dilute Power of Flu Shots
With flu vaccination season in full swing, research from the University of Rochester Medical Center cautions that use of many common pain killers - Advil, Tylenol, aspirin - at the time of injection may blunt the effect of the shot and have a negative effect on the immune system.
News brief: Effects of aspirin and folic acid on inflammation markers for colorectal adenomas
Unexpectedly, inflammation markers do not appear to be involved with the chemopreventative effect of aspirin on colorectal adenomas, according to a brief communication published online October 12 in the Journal of the National Cancer Institute.
Aspirin Misuse May Have Made 1918 Flu Pandemic Worse
The devastation of the 1918-1919 influenza pandemic is well known, but a new article suggests a surprising factor in the high death toll: the misuse of aspirin.
Cogent trial shows lack of adverse interaction between clopidogrel and stomach medicine
Results from a late breaking clinical trial called COGENT demonstrate that the combination of giving patients clopidogrel, a blood thinner commonly prescribed to patients with cardiovascular disease, and stomach medicines such as omeprazole, known as proton pump inhibitors (PPIs), did not lead to adverse events, as some prior studies had suggested.
Aspirin works for primary prevention in moderate and high risk diabetics
The beneficial effects of aspirin in primary prevention of cardiovascular events i.e. stroke, MI and cardiac death are known and generally accepted.
New strategies for reperfusion therapy
A new trial has begun in order to ascertain once and for all whether the best strategy for patients who cannot receive P-PCI is early fibrinolysis, together with mandated angiography.
Small peptide found to stop lung cancer tumor growth in mice
In new animal research done by investigators at Wake Forest University School of Medicine, scientists have discovered a treatment effective in mice at blocking the growth and shrinking the size of lung cancer tumors, one of the leading causes of cancer death in the world.
Genetic variation associated with poorer response, cardiovascular outcomes with use of clopidogrel
Patients with a certain genetic variation who received the antiplatelet drug clopidogrel had a decreased platelet response to treatment and among those who had percutaneous coronary intervention (procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) had an increased risk of having a cardiovascular event in the following year than patients who did not have this variant, according to a study in the August 26 issue of JAMA.
Study reveals mounting evidence of fish oil's heart health benefits
There is mounting evidence that omega-3 fatty acids from fish or fish oil supplements not only help prevent cardiovascular diseases in healthy individuals, but also reduce the incidence of cardiac events and mortality in patients with existing heart disease.
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