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PubMed2003

Rates of serious gastrointestinal events from low dose use of acetylsalicylic acid, acetaminophen, and ibuprofen in patients with osteoarthritis and rheumatoid arthritis.

OBJECTIVE: The frequency of serious gastrointestinal (GI) complications has been quantitated with chronic high doses of nonsteroidal antiinflammatory drugs (NSAID), but risk at lower dosages remains unknown. We examined the prevalence of serious GI events in patients taking aspirin (ASA), acetaminophen (APAP), or ibuprofen (IBU), focusing on low or intermittent use. METHODS: We studied 5692 patients with rheumatoid arthritis (RA) and 3124 patients with osteoarthritis (OA) from 12 databank centers, with 36,262 patient-years of observation, who had taken one of 3 study analgesics, and examined the frequency of serious GI events requiring hospitalization. RESULTS: Treatment groups were of similar ages and severity. As lower doses of study analgesics were taken, serious GI events tended to be less prevalent. In patients taking a study drug alone, without other analgesics or corticosteroids, only one event occurred in over 900 patient-years of exposure, roughly equivalent to background. Rates of GI events while taking APAP with other concurrent therapy or corticosteroids were higher (p < 0.05) than for the other 2 analgesics. In over-the-counter (OTC) doses, there were no significant differences in GI toxicity among analgesics. RA patients tended to have higher rates than OA patients. The rate of GI events was highly dependent on concurrent therapy, increasing 2 to 6-fold in patients taking other analgesics or corticosteroids. Propensity scores for serious GI events were similar across drugs. CONCLUSION: OTC use of ASA, IBU, or APAP carries little risk of serious GI toxicity for most persons. Most serious problems encountered were in higher-risk patients. Given the low rates of events, at low or intermittent dosage without concurrent treatment, these 3 analgesics cannot be distinguished from each other or from background rates of serious GI toxicity.

Acetaminophen↗
PubMed2003

[To what extent does Trasylol decrease the need for blood and blood derivatives in postoperative acetylsalicylic acid (ASA)-induced hemorrhage in CABG surgery?].

ASA is commonly used for many years as pain relief drug, anti-inflammatory and against temperature, as well as antiaggregatory agent in coronary disease therapy. Aprotinin (Trasylol) has antifibrinolytic properties, among other actions, inhibits intrinsic coagulation cascade, and it has been demonstrated to reduce blood loss. Can be given in different doses and by different protocols. It is frequently used in cardiosurgery to reduce postoperative bleeding in the cases when ASA is not stopped at the right time before surgery. We evaluated the effects of therapeutic ASA doses on postoperative bleeding in patients undergoing coronary bypass grafting (CABG) compared with usage of Trasylol in CABG, bleeding and blood and fresh frozen plasma (FFP) requirements. This is a retrospective study, period October 1998-March 2002. Out of total CABG patients 75 fulfilled criteria (elective surgery, first CABG)--they were divided into following groups: ASA group of 25 patients (ASA withdrawn 1-3 days before surgery), Non ASA group of 25 patients (ASA withdrawn 10 or more days before surgery) and Trasylol group of 25 patients (ASA till surgery plus Trasylol intraoperatively). Average bleeding in ASA group 24 hours postoperatively was 1600 ml, Non ASA group had average bleeding 900 ml, while Trasylol group had average drainage of 700 ml after 24 hours. ASA average blood requirement was 1800 ml, 250 ml FFP and 250 ml 5% albumin, Non ASA group has less need for blood and FFP--250 ml blood, 50 ml FFP and 30 ml 5% albumin. Our Trasylol group had quite profound bleeding and high requirements for blood and FFP--average 850 ml blood, 200 ml FFP and 150 ml 5% albumin. We recommend discontinuation of ASA therapy sufficiently early for all elective CABG, because in our case Trasylol did not give satisfactory decrease in postoperative bleeding and blood and FFP requirements. That all increase possibility of postoperative complication occurrence and increase CABG costs.

Adult↗
PubMed2003

[Therapeutic use of acetylsalicylic acid in diabetics].

Aterosclerosis is a leading cause of morbidity and mortality in diabetics. Macrovascular diseases--myocardial infarction, cerebral vascular accident, ischemic lower extremities--start in persons with diabetes earlier and in a bigger scope then in non-diabetics. Development of these changes is determined by diabetic vasculopathy which is connected with endothelial dysfunction, hypercoagulation state, and platelet abnormalities. Treatment of a patient with diabetes is based on compensation of diabetes and management of hypertension and dyslipidaemia. Drugs that inhibit platelets constitute an important part of prevention of cardiovascular disabilities in diabetics.

Aspirin↗