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Oral acetylsalicylic acid induces biliary cholesterol secretion in the rat.

Several agents can alter biliary cholesterol secretion, critical for cholesterol excretion and gallstone formation. Although salicylate effects on bile formation and gallstones have been studied, biliary lipid secretion has not been measured during oral aspirin treatment. We examined whether oral acetylsalicylic acid affects bile lipid secretion. Three groups of young rats were fed chow for 3 wk. Two of the groups then received aspirin at either 1.67 or 3.33 g/kg diet for 4 d. Serum, hepatic, and bile lipids were measured, as were enzymes of cholesterol synthesis and esterification. With oral aspirin, bile cholesterol secretion increased by 42% and hepatic cholesteryl ester content decreased by 40%. Serum cholesterol and hepatic free cholesterol did not change. To evaluate mechanisms of the cholesterol hypersecretion, hypothyroid animals fed low-fat or fish oil diets and repleted with triiodothyronine were also studied. Aspirin stimulated cholesterol secretion to a degree similar to triiodothyronine. An additive response was seen in fish oil-fed rats. Aspirin did not appear to have a primary action on 3-hydroxy-3-methylglutaryl-CoA reductase or acyl CoA:cholesterol acyltransferase activities, and had no direct effect on esterification of cholesterol by isolated hepatocytes. Aspirin may directly increase cholesterol transport into bile or have cell membrane effects which alter cholesterol transport. It remains to be determined whether the observed alterations in bile cholesterol secretion are specific to the rat or also apply to humans.

Administration, Oral↗

Low dose acetylsalicylic acid and thromboxane release at the site of plug formation in vivo in elderly patients with cardiovascular disease.

Thromboxane B2 (TXB2) levels in bleeding time blood and in serum were measured in 13 elderly patients with cardiovascular disease, seven of whom were receiving continuous treatment with low dose acetylsalicylic acid (ASA, 125 mg every second day--250 mg daily) for prevention of stroke. Blood sampling was performed openly, but assays of TXB2 were performed by a blinded investigator. In patients treated with ASA, median serum TXB2-levels were 4% and TXB2-levels in bleeding-time blood were less than 16% of the corresponding levels in patients without ASA (P less than 0.01). The results show that in elderly atherosclerotic patients very low doses of ASA substantially suppress TXB2 formation, not only in serum but also at the site of local haemostasis. The extent of suppression is comparable to that previously reported from young healthy subjects.

Aged↗

Acetylsalicylic acid vs. metoprolol in migraine prophylaxis--a double-blind cross-over study.

In a double blind cross-over study, 28 patients, 5 male and 23 female, aged 31 +/- 14 years, after a run-in period of 8 weeks, were treated for 3 months with acetylsalicylic acid and for another 3 months with metoprolol, both in a prophylactic mode. Attack frequency was reduced significantly with both therapeutic regimens (ASA p less than 0.001, metoprolol p less than 0.00005). Reduction of attacks below 50% was seen with metoprolol in 14 cases, and with ASA in three cases. Even though ASA was of statistically significant efficacy in migraine prophylaxis, it clearly is not the drug of first choice in migraine prophylaxis.

Adult↗

Acetylsalicylic acid loaded poly(vinyl alcohol) hemodialysis membranes: effect of drug release on blood compatibility and permeability.

Membranes developed from poly(vinyl alcohol) (PVA) have superior permeability because of the highly hydrophilic character of PVA. However, its blood compatibility needs to be further improved. For this we have developed acetylsalicylic acid (ASA, aspirin) loaded PVA membranes. It seems that the slow release of aspirin from the membrane provides a surface concentration of aspirin sufficient for partially inhibiting platelet adhesion. PVA membrane with 531 micrograms cm-2 of ASA loaded, may be selected for hemodialysis applications. This may help to reduce the amount of heparin infused during hemodialysis, thereby reducing the side-effects associated with the systemic administration of heparin.

Anticoagulants↗

Indomethacin and acetylsalicylic acid reduce intrapulmonary shunt in experimental pneumococcal pneumonia.

Arterial hypoxemia in acute experimental pneumococcal pneumonia is caused primarily by persistence of pulmonary blood flow to lung regions consolidated by pneumonia, which results in an intrapulmonary shunt. In order to test the hypothesis that in acute pneumonia indomethacin or acetylsalicylic acid (ASA) would improve gas exchange, as has been observed in some other disease models, 15 pentobarbital-anesthetized dogs with acute lobar pneumonia caused by Streptococcus pneumoniae type 3 were studied. After baseline measurements of pulmonary gas exchange, central hemodynamics and radionuclide-labeled microsphere determination of regional distribution of pulmonary blood flow, the dogs were randomly assigned to receive an intravenous infusion of indomethacin (2 mg/kg, n = 5), ASA, (100 mg/kg, n = 5) or a saline infusion (control, n = 5). All measurements were then repeated 30 and 60 min after infusion. Although there were no significant changes in the control group, PaO2 during O2 ventilation increased from a mean +/- SD value of 104 +/- 46 mmHg at baseline to 180 +/- 73 mmHg after ASA and from 262 +/- 173 to 361 +/- 134 mmHg after indomethacin. These improvements in PaO2 were associated with a decrease in shunt from 0.38 +/- 0.12 to 0.23 +/- 0.03 with ASA and from 0.29 +/- 0.21 to 0.21 +/- 0.08 with indomethacin. The reduction in shunt in both treatment groups was attributable to a fall in the fraction of the pulmonary blood flow perfusing the consolidated lung regions, from 33 +/- 8 to 21 +/- 5% after ASA and from 33 +/- 12 to 22 +/- 9% after indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Human platelet aggregation and release reaction induced by platelet activating factor (PAF-acether)--effects of acetylsalicylic acid and external ionized calcium.

The effects of the cyclo-oxygenase inhibition on PAF-acether-induced human platelet aggregation and secretion are controversial. We studied the above parameters on citrated platelet-rich plasma of 12 normal subjects before and after the in vivo administration of acetylsalicylic acid (ASA). Individual sensitivities to PAF-acether were highly variable. ASA completely inhibited the platelet secretion induced by low concentrations of PAF-acether, but caused only partial inhibition when platelets were exposed to high concentrations of PAF-acether. The concentration of PAF-acether which overcame the cyclo-oxygenase inhibition varied substantially, depending on the individual sensitivity of the platelets to it. The addition of CaCl2 2 mM to the samples did not affect the extent of the platelet secretion, but increased irreversible aggregation in samples taken both before and after the ASA administration. These data suggest that low concentrations of PAF-acether stimulate the human platelet secretion by activating the cyclo-oxygenase pathway, whereas higher concentrations also trigger other mechanism(s) that suffice to induce human platelet secretion and full aggregation.

Aspirin↗

Acetylsalicylic acid 100 mg and 1000 mg daily in acute myocardial infarction suspects: a placebo-controlled trial.

Of 1078 patients admitted to the coronary care unit with acute chest pain, 293 who had possible acute myocardial infarction and symptoms of median 4 h duration were randomized to treatment with acetylsalicylic acid (ASA) 100 mg daily, 1000 mg daily or placebo for 3 months. During hospitalization, the combined incidence of cardiac death and non-fatal myocardial infarction on-treatment (withdrawals not included) was significantly lower (P less than 0.02) in the 100 mg group (7.1%) than in both the 1000 mg group (20.8%) and the placebo group (19.7%). During later time periods of treatment and at all time periods analysed according to the intention-to-treat principle (withdrawals included), data suggested the same trend, but differences were not statistically significant. Collagen-induced platelet aggregation and serum thromboxane B2 were reduced to the same degree in the two ASA groups and were normal in the placebo group. The data suggest that low-dose ASA could be cheap and safe as first-aid therapy in myocardial infarction suspects.

Aspirin↗

The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study.

We investigated efficacy, safety, and tolerability of two tablets of the fixed combination of 250 mg acetylsalicylic acid (ASA) + 200 mg paracetamol + 50 mg caffeine (Thomapyrin) in comparison with two tablets of 250 mg ASA + 200 mg paracetamol, two tablets of 500 mg ASA, two tablets of 500 mg paracetamol, two tablets of 50 mg caffeine, and placebo in patients who were used to treating their episodic tension-type headache or migraine attacks with non-prescription analgesics. For the primary endpoint "time to 50% pain relief" in the intention-to-treat dataset (n = 1743 patients), the fixed combination of ASA, paracetamol and caffeine was statistically significantly superior to the combination without caffeine (P = 0.0181), the mono-substances ASA (P = 0.0398), paracetamol (P = 0.0016), caffeine (P < 0.0001) and placebo (P < 0.0001). All active treatments except caffeine differed significantly (P < 0.0001) from placebo. The superior efficacy of the triple combination could also be shown for all secondary endpoints such as time until reduction of pain intensity to 10 mm, weighted sum of pain intensity difference (%SPIDweighted), extent of impairment of daily activities, global assessment of efficacy. All treatments were well tolerated. The incidence of adverse events observed was low.

Acetaminophen↗

Antithrombotic effects of ximelagatran plus acetylsalicylic acid (ASA) and clopidogrel plus ASA in a human ex vivo arterial thrombosis model.

It was the objective of this study to compare the antithrombotic effects and bleeding profiles of the oral direct thrombin inhibitor ximelagatran, an anticoagulant, and the antiplatelet agent clopidogrel on top of steady-state acetylsalicylic acid (ASA) in a human arterial thrombosis model. Healthy male volunteers (n=62) received ASA (160 mg once daily), plus either clopidogrel for 6 days (loading dose 300 mg, then 75 mg once daily), or a single dose of ximelagatran (36 or 72 mg) on Day 6. Changes in total thrombus area (TTA) under low shear rate (LSR; 212 s(-1)) and high shear rate (HSR; 1690 s(-1)) conditions were measured, using the ex vivo Badimon perfusion chamber model pre-dose and 2 and 5 hours after dosing on Day 6, and capillary bleeding times (CBT) were determined. Ximelagatran plus ASA significantly reduced TTA under LSR and HSR, compared with ASA alone. Ximelagatran plus ASA reduced TTA more than clopidogrel plus ASA under LSR after 2 hours (36 mg, P=0.0011; 72 mg, P<0.0001) and 5 hours (72 mg, P=0.0057), and under HSR after 2 and 5 hours (72 mg, P<0.05). Compared with ASA alone, CBT was markedly prolonged by clopidogrel plus ASA (ratio 6.4; P<0.0001) but only slightly by ximelagatran plus ASA (72 mg ximelagatran, ratio 1.4; P=0.0010). Both drug combinations were well tolerated. Oral ximelagatran plus ASA has a greater antithrombotic effect in this human ex vivo thrombosis model and a less pronounced prolongation of bleeding time than clopidogrel plus ASA.

Administration, Oral↗

[Measuring the potential difference of gastric mucosa as a means of quantifying the protective effect of Al-acetylglycyrrhetinate after a dose of acetylsalicylic acid (author's transl)].

A clinical pharmacological model to measure the potential difference of the gastric mucosa is reported. The model partially from literature derived has been further developed mathematically. An irritation index is reliable to quantify the protective function of chemical agents. In the reported study Al-acetylsalicylic acid (ASA): The measured parameters (Pdmax, AUB) show that the irritation of the gastric mucosa induced by ASA can be reduced if 100 mg Al-acetylglycyrrhetinate has been predosed. After the instillation of 1000 mg ASA the mean Pdmax amounts to 27.20 [mV] (s = 9.63), the AUB to 930.60 [mV . mins] (s = 311.10). After pre-treatment with Al-acetylglycyrrhetinate the irritation of ASA only produces a Pdmax of 17.80 [mV] (s = 986) and and AUB of 678.60 [mV . min] (s = 374.11). The differences of Pdmax and AUB are significant on the 5% level. The irritation index for 1000 mg ASA amounts to 27.5 [mV2 . min], after pre-treatment with 100 mg Al-acetylglycyrrhetinate it decrease to 14.9 [mV2 . min].

Adult↗

Piracetam versus acetylsalicylic acid in secondary stroke prophylaxis. A double-blind, randomized, parallel group, 2 year follow-up study.

Piracetam has been shown to inhibit platelet aggregation. Therefore, we performed a double-blind, randomized, parallel group study to compare the efficacy of daily 1600 mg piracetam t.i.d. vs. 200 mg acetylsalicylic acid (ASA) t.i.d. in secondary stroke prophylaxis. 563 patients after stroke as confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled and received either piracetam or ASA during a 2 year follow-up period. The primary endpoint was the rate of stroke, transient ischaemic attack (TIA), or death from vascular cause. The secondary endpoint was the rate of adverse events leading to a premature discontinuation of the study medication. Patients were visited at home every 3 months and were examined in hospital after 1 and 2 years. At every visit, the platelet function was evaluated. No significant difference and no significant equivalence could be shown for the primary endpoint between the piracetam and the ASA group both in the intention-to-treat and in the per-protocol analysis. However, there was a not significant trend in favor of ASA (11.7 vs. 15.2%). After excluding those patients who did not respond to antiplatelet medication in vitro, however, piracetam and ASA were equivalent in secondary stroke prophylaxis (stroke, TIA, or vascular death 10.1% in the piracetam group vs. 9.7% in the ASA group). Piracetam was significantly superior to ASA in the secondary endpoint (P=0.0039). The data suggest that the overall efficacy of piracetam in secondary stroke prophylaxis is not as good as that of ASA but that piracetam is better tolerated. However, our data furthermore show that nonresponders to pharmacological inhibition of platelet function are more frequent under piracetam therapy and that they may influence the results of large studies on secondary prophylaxis in vascular diseases.

Aspirin↗

The effect of acetylsalicylic acid and captopril on uterine and ovarian blood flow during the estrous cycle in mares.

In previous studies, transrectal color Doppler sonography was used to demonstrate an increase in genital blood flow resistance in subfertile mares. The objectives of the present study were to determine the effects of an anticoagulant (acetylsalicylic acid) and a vasodilator (captopril) on uterine and ovarian perfusion and plasma progesterone concentrations in cycling mares. From Day 1 to 11 of an estrous cycle (Day 0=day of ovulation following prostaglandin-induced luteolysis), five Trotter mares were given 2500 mg lactose, 2500 mg ASA, or 50 mg captopril twice daily in their feed (one compound per cycle, in random order). Transrectal color Doppler sonography was used to examine both uterine arteries and the ovarian artery ipsilateral to the corpus luteum once daily, immediately prior to administration of the drug. Blood flow resistance was determined semiquantitatively using the pulsatility index (PI) and plasma progesterone concentrations were determined with an enzyme immunoassay. Compared to the placebo, both ASA and captopril decreased mean PI values of both uterine arteries of all mares. On average, ASA decreased the PI of the uterine arteries by 25%; this was more (P<0.05) than the average decrease (13%) caused by captopril. Both drugs decreased (P<0.05) blood flow resistance in the ovarian arteries, although there was no difference (P<0.05) in their efficacy. In addition, both ASA and captopril increased (P<0.0001) plasma progesterone concentrations (18 and 17%, respectively). In conclusion, either ASA or captopril improved uterine and ovarian perfusion; however the effects on fertility were not determined.

Animals↗

Cyclooxygenase inhibition with acetylsalicylic acid unmasks a role for prostacyclin in erythropoietin-induced hypertension in uremic rats.

We previously reported that thromboxane (TX)A2 synthesis and receptor blockade prevented recombinant human erythropoietin (rhEPO)-induced hypertension in chronic renal failure rats. The present study was designed to investigate the effect of a cyclooxygenase inhibitor, acetylsalicylic acid (ASA), on blood pressure, renal function, and the concentration of eicosanoïds and endothelin-1 (ET-1) in vascular and renal tissues of rhEPO-treated or rhEPO-untreated uremic rats. Renal failure was induced by a 2-stage 5/6 renal mass ablation. Rats were divided into 4 groups: vehicle, rhEPO (100 U/kg, s.c., 3 times per week), ASA (100 mg x kg(-1) x day(-1), and rhEPO + ASA; all animals were administered drugs for 3 weeks. The TXA2- and prostacyclin (PGI2)-stable metabolites (TXB2 and 6-keto-PGF1alpha, respectively), as well as ET-1, were measured in renal cortex and either the thoracic aorta or mesenteric arterial bed. The uremic rats developed anemia, uremia, and hypertension. They also exhibited a significant increase in vascular and renal TXB2 (p < 0.01) and 6-keto-PGF1alpha (p < 0.01) concentrations. rhEPO therapy corrected the anemia but aggravated hypertension (p < 0.05). TXB2 and ET-1 tissue levels further increased (p < 0.05) whereas 6-keto-PGF1alpha was unchanged in rhEPO-treated rats compared with uremic rats receiving the vehicle. ASA therapy did not prevent the increase in systolic blood pressure nor the progression of renal disease in rhEPO-treated or rhEPO-untreated uremic rats, but suppressed both TXB2 and 6-keto-PGF1alpha tissue concentrations (p < 0.05). ASA had no effect on vascular and renal ET-1 levels. Cyclooxygenase inhibition had no effect on rhEPO-induced hypertension owing, in part, to simultaneous inhibition of both TXA2 and its vasodilatory counterpart PGI2 synthesis, whereas the vascular ET-1 overproduction was maintained. These results stress the importance of preserving PGI2 production when treating rhEPO-induced hypertension under uremic conditions.

6-Ketoprostaglandin F1 alpha↗

Acetylsalicylic acid and the balance between prostacyclin and thromboxane A2.

Arachidonic acid is metabolized in endothelial cells to antiaggregatory, vasodilatory prostacyclin (PGI2), and in platelets to aggregatory, vasoconstrictory thromboxane A2 (TxA2). The balance of these two prostanoids is supposed to be involved with thrombogenesis and atherogenesis. Acetylsalicylic acid (ASA) inhibits irreversibly the key enzyme of the synthesis of these prostanoids, i.e. cyclo-oxygenase. Platelets do not synthetize new protein, but endothelial cells do. Because of this, and certain pharmacokinetic characteristics of ASA, it should be possible to shift the balance between PGI2 and TxA2 to the dominance of the former with the proper dose of this drug. Altogether more than 50,000 subjects have volunteered for studies on the effect of ASA in the primary or secondary prevention of myocardial infarction or ischemic stroke. The results show that it is possible to reduce vascular attacks by ASA. Furthermore, ASA has also found to prevent pre-eclampsia. Conclusions on the effect of ASA on the PGI2/TxA2-balance are hampered by uncertainties concerning the measurement PGI2 and TxA2 productions in vivo. It is, however, evident that the doses of ASA used in most trials have been high enough to inhibit partly also the production of PGI2. Whether smaller doses or less frequent administration would be more efficient, remains to be studied.

Arteriosclerosis↗

Therapeutic effects of acetylsalicylic acid in giant cell arteritis.

OBJECTIVE: In giant cell arteritis (GCA), inflammatory lesions typically produce interferon-gamma(IFNgamma)-- and nuclear factor kappaB (NF-kappaB)-dependent monokines. Corticosteroids influence disease activity by repressing NF-kappaB-dependent genes but have only marginal effects on IFNgamma. The current study explored whether acetylsalicylic acid (ASA) had cytokine-repressing activity in GCA and could function as a steroid-sparing agent. METHODS: Temporal artery-severe combined immunodeficiency (SCID) mouse chimeras were created by engrafting inflamed temporal arteries into SCID mice. Chimeras were treated with ASA, indomethacin, or dexamethasone for 3 weeks. Temporal artery grafts were harvested and cytokine message was semiquantified by polymerase chain reaction-enzyme-linked immunosorbent assay. The ability of dexamethasone and ASA to suppress IFNgamma and interleukin-1beta (IL-1beta) messenger RNA and protein production was also tested in vitro using T cell clones and monocytes derived from patients with GCA. Drug-induced effects on the transcription factors NF-kappaB and activator protein 1 (AP-1) were assessed by electrophoretic mobility shift assays (EMSAs). RESULTS: At clinically relevant doses, 20-100 mg/kg, ASA was a highly effective inhibitor of cytokine transcription in temporal arteries. While dexamethasone preferentially targeted NF-kappaB-regulated monokines, ASA acted predominantly by suppressing IFNgamma. Indomethacin failed to reduce tissue IFNgamma transcription, which therefore excluded the inhibition of cyclooxygenases as a critical mechanism. IFNgamma production by T cell clones was highly sensitive to ASA-mediated suppression, whereas IL-1beta production by lipopolysaccharide-stimulated monocytes responded primarily to dexamethasone. The combination of ASA and dexamethasone had synergistic effects. EMSAs demonstrated that ASA interfered with the formation of AP-1, whereas dexamethasone suppressed the nuclear translocation of NF-kappaB. CONCLUSION: The results of this study provide evidence of the complementary action of ASA and corticosteroids in suppressing proinflammatory cytokines in the vascular lesions of GCA.

Animals↗

Single dose of acetylsalicylic acid prevents thromboxane release after tourniquet ischemia.

BACKGROUND: Ischemia, such as that caused by a tourniquet, stimulates thromboxane (Tx) A(2) synthesis. TxA(2) might sensitize the operated limb to various complications, such as compartment syndrome and thromboembolic events. METHODS: We studied the effect of pretreatment with a single dose of acetylsalicylic acid (ASA) (25, 100, and 500 mg) given 3 hours before surgery on the formation of TxB(2), a stable metabolite of TxA(2), after tourniquet deflation in 32 knee or ankle surgery patients. RESULTS: Tourniquet time varied between 60 +/- 8 to 71 +/- 7 (SE) minutes. In control patients without ASA pretreatment, the platelet-produced femoral vein serum TxB(2) concentration over 30 minutes in vitro coagulation increased remarkably (from 40.0 +/- 20 ng/mL to 73.5 +/- 39 ng/mL) immediately after tourniquet deflation. Plasma concentrations increased similarly, approximately threefold. Pretreatment with 100 or 500 mg ASA prevented the increase in TxB(2) concentrations. Radial artery concentrations of TxB(2) were similar to venous concentrations in the different treatment groups. CONCLUSION: Pretreatment with a single 100-mg dose of ASA prevents the release of TxB(2) after tourniquet deflation.

Adult↗

Effects of paracetamol and acetylsalicylic acid on the post-operative course after experimental orthopaedic surgery in dogs.

In placebo-controlled cross-over trials in dogs, two 'identical' operations were performed on the forelimbs of each animal with an interval of 28 days, to evaluate how daily doses of 1.5 g paracetamol, 1.5 g acetylsalicylic acid (ASA) and 0.5 g ASA might modulate an acute post-operative inflammatory reaction. On the third post-operative day the reductions in swelling compared with placebo averaged 33% with 1.5 g paracetamol (P = 0.02), 24% with 1.5 g ASA (P = 0.03) and 15% with 0.5 g ASA (P = 0.18); while the reductions in pain estimates averaged 47% with 1.5 g paracetamol (P = 0.01), 32% with 1.5 g ASA (P = 0.07) and 28% with 0.5 g ASA (P = 0.21). There were no clinical signs of adverse drug effects, such as vomiting, haematochezia, cyanosis or depression. The results disagree with the traditional view that paracetamol has little or no anti-inflammatory effect, and demonstrate that paracetamol may reduce an acute inflammatory reaction, at least as efficiently as ASA. The potential pro-inflammatory effect of ASA in low doses is discussed. It is concluded that paracetamol appears to be a valuable drug against post-operative or post-traumatic sequelae in the veterinary as well as in the human clinic.

Acetaminophen↗