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[Primary prevention of cardiovascular diseases with acetylsalicylic acid].

BACKGROUND AND OBJECTIVE: Although the benefit of aspirin for patients with known cardiovascular disease is well established, the protective effect in primary prevention remains the subject of a controversial discussion. This meta-analysis was undertaken to ascertain whether a risk reduction regarding mortality and/or cardiovascular events can be achievement with aspirin in persons without known cardiovascular disease? METHODS: A systematic literature search for randomized controlled trials and meta-analyses was done. RESULTS: Six relevant primary trials and three meta-analyses were found. The validity of three of the trials and thus also the meta-analyses was limited by inclusion of patients with known cardiovascular disease. Therapy with aspirin showed no reduction in terms of overall mortality rate or rate of cardiovascular death. In men the primary prevention with aspirin reduced the risk of a non-fatal myocardial infarction with an annual numbers needed to treat of about 670. There was no equivalent effect in women (except for women (3) 65 years). A reduction of stroke events was only seen in the Women's Health Study, which included only female participants. The effect was quite small, the annual numbers needed to treat were about 3890. An equivalent benefit for men was not proven in any of the other trials. CONCLUSION: In view of the absence of life prolonging effect and no possibility of determining a definite risk group, that would have a special or accessory effect from a primary prevention with aspirin, there is no indication for such a scheme.

Aspirin↗

[Clinical study of the labour inhibiting effects an side effects of acetylsalicylic acid (ASA) (author's transl)].

In 37 pregnancy women preterm labour was inhibited with intravenous administration of ASA. 20 patients (Group I) had a combined treatment of ASA and Fenoterol. 7 pregnant women (Group II) without successful labour inhibition under Fenoterol were treated with ASA subsequently. In a third group of 10 women we administered ASA alone. The treatment was considered as successful if signs of preterm labour stopped and pregnancy maintained for 7 days or more. In the first group 16, in the second group all patients had been treated successfully. In group III we succeeded in labour inhibiting for more than 7 days in 6 cases. An initial loading dose of 5.5 to 7.0 mn/min ASA had been infused for 24 hours. If preterm labour was stopped, the dosage had been reduced. In all patients dose related but reversible symptoms of vertigo, tinnitus, headache and hyperventilation were seen. Furthermore we found a non-dose-dependent prolongation ( by 30% or normal) of bleeding time. In the fetus respectively the newborn an affection by this ASA treatment could be excluded. We propose inhibition of preterm labour by i.v. ASA administration in all pregnant women if beta-mimetic drugs are not successful or an intolerance is diagnosed. Contraindications for ASA therapy are mentioned.

Aspirin↗

[A comparison of the gastroduodenal tolerance of ticlopidine and acetylsalicylic acid].

Changes in the gastroduodenal mucosa caused by 250 mg ticlopidine twice daily (group 1; n = 12) or 300 mg aspirin daily (group 2; n = 12) were compared in a randomized double-blind trial of 24 healthy men, aged 20 to 35 years. An oesophago-gastroduodenoscopy was performed before and after either drug had been taken for 7 days. Results were tabulated according to a uniform scoring system (normal mucosa, erythema, petechiae, erosions, ulcer, and blood in the lumen). Both groups had identical scores at the start of the trial (group 1: 0.9 +/- 0.1; group 2: 0.8 +/- 0.1). After the seven days, the score in group 2 had risen to 9.7 +/- 1.5 (median 9.0), while it had hardly changed in group 1 (1.7 +/- 0.5; median 1.0), a statistically significant difference (P < 0.05). The data indicate that ticlopidine is better tolerated by the gastroduodenal mucosa than low dosage aspirin.

Adult↗