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Nadroparin plus aspirin versus aspirin alone in the treatment of acute ischemic stroke  [cached]
Sarma G,Roy A
Neurology India , 2003,
Abstract: Low-molecular-weight-heparin (LMWH) has been widely used in the treatment of acute ischemic stroke but controlled trials are few. In this study, 40 patients with acute ischemic stroke of less than 24 hours duration were randomized to receive either aspirin (325 mg/day) alone or aspirin (325 mg/day) plus subcutaneous nadroparin 4100 units/day. At the end of 4 weeks, the morbidity and mortality were significantly less in the nadroparin group as compared to the aspirin group. There was no increased risk of clinically significant intracranial hemorrhage in either group. The combination of aspirin and LMWH deserves to be tested in larger studies.
Comparative effect of clopidogrel plus aspirin and aspirin monotherapy on hematological parameters using propensity score matching
Hayasaka M, Takahashi Y, Nishida Y, Yoshida Y, Hidaka S, Asai S
Vascular Health and Risk Management , 2013, DOI: http://dx.doi.org/10.2147/VHRM.S39351
Abstract: mparative effect of clopidogrel plus aspirin and aspirin monotherapy on hematological parameters using propensity score matching Original Research (603) Total Article Views Authors: Hayasaka M, Takahashi Y, Nishida Y, Yoshida Y, Hidaka S, Asai S Published Date February 2013 Volume 2013:9 Pages 65 - 70 DOI: http://dx.doi.org/10.2147/VHRM.S39351 Received: 18 October 2012 Accepted: 10 December 2012 Published: 18 February 2013 Masatoshi Hayasaka,1 Yasuo Takahashi,2 Yayoi Nishida,2 Yoshikazu Yoshida,1 Shinji Hidaka,3 Satoshi Asai4 1Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, 2Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Tokyo, 3Laboratory of Pharmaceutical Regulatory Science, Department of Pharmacy, School of Pharmacy, Nihon University, Chiba, 4Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Tokyo, Japan Background: Clopidogrel and aspirin are antiplatelet agents that are recommended to reduce the risk of recurrent stroke and other cardiovascular events. Dual antiplatelet therapy with clopidogrel and aspirin has been shown to increase the risk of hemorrhage, but the effects of the drugs on laboratory parameters have not been well studied in real-world clinical settings. Therefore, we evaluated and compared the effects of combination therapy with clopidogrel plus aspirin and aspirin monotherapy on laboratory parameters. Methods: We used data from the Nihon University School of Medicine Clinical Data Warehouse obtained between November 2004 and May 2011 to identify cohorts of new users (n = 130) of clopidogrel (75 mg/day) plus aspirin (100 mg/day) and a propensity score matched sample of new users (n = 130) of aspirin alone (100 mg/day). We used a multivariate regression model to compare serum levels of creatinine, aspartate aminotransferase, and alanine aminotransferase, as well as hematological parameters including hemoglobin level, hematocrit, and white blood cell, red blood cell, and platelet counts up to 2 months after the start of administration of the study drugs. Results: There were no significant differences for any characteristics and baseline laboratory parameters between users of clopidogrel plus aspirin and users of aspirin alone. Reductions in white blood cell and red blood cell counts, hemoglobin levels, and hematocrit in users of clopidogrel plus aspirin were significantly greater than those in users of aspirin alone. Conclusion: Our findings suggest that adverse hematological effects may be greater with combination clopidogrel plus aspirin therapy than with aspirin monotherapy.
Comparative effect of clopidogrel plus aspirin and aspirin monotherapy on hematological parameters using propensity score matching  [cached]
Hayasaka M,Takahashi Y,Nishida Y,Yoshida Y
Vascular Health and Risk Management , 2013,
Abstract: Masatoshi Hayasaka,1 Yasuo Takahashi,2 Yayoi Nishida,2 Yoshikazu Yoshida,1 Shinji Hidaka,3 Satoshi Asai41Department of Pharmacy, Nihon University Itabashi Hospital, Tokyo, 2Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, Tokyo, 3Laboratory of Pharmaceutical Regulatory Science, Department of Pharmacy, School of Pharmacy, Nihon University, Chiba, 4Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, Tokyo, JapanBackground: Clopidogrel and aspirin are antiplatelet agents that are recommended to reduce the risk of recurrent stroke and other cardiovascular events. Dual antiplatelet therapy with clopidogrel and aspirin has been shown to increase the risk of hemorrhage, but the effects of the drugs on laboratory parameters have not been well studied in real-world clinical settings. Therefore, we evaluated and compared the effects of combination therapy with clopidogrel plus aspirin and aspirin monotherapy on laboratory parameters.Methods: We used data from the Nihon University School of Medicine Clinical Data Warehouse obtained between November 2004 and May 2011 to identify cohorts of new users (n = 130) of clopidogrel (75 mg/day) plus aspirin (100 mg/day) and a propensity score matched sample of new users (n = 130) of aspirin alone (100 mg/day). We used a multivariate regression model to compare serum levels of creatinine, aspartate aminotransferase, and alanine aminotransferase, as well as hematological parameters including hemoglobin level, hematocrit, and white blood cell, red blood cell, and platelet counts up to 2 months after the start of administration of the study drugs.Results: There were no significant differences for any characteristics and baseline laboratory parameters between users of clopidogrel plus aspirin and users of aspirin alone. Reductions in white blood cell and red blood cell counts, hemoglobin levels, and hematocrit in users of clopidogrel plus aspirin were significantly greater than those in users of aspirin alone.Conclusion: Our findings suggest that adverse hematological effects may be greater with combination clopidogrel plus aspirin therapy than with aspirin monotherapy.Keywords: clopidogrel, aspirin, laboratory parameter, antiplatelet therapy, propensity score matching
The Efficacy and Adverse Reaction of Bleeding of Clopidogrel plus Aspirin as Compared to Aspirin Alone after Stroke or TIA: A Systematic Review  [PDF]
Yan Huang, Man Li, Jian-Yong Li, Min Li, Yuan-Peng Xia, Ling Mao, Bo Hu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0065754
Abstract: Background and Purpose Given the high risk of stroke after TIA (transient ischemia attack) or stroke and the adverse reaction of bleeding of antiplatelets, we undertook a meta-analysis, reviewed randomized controlled trials (RCTs) comparing aspirin plus clopidogrel with aspirin alone to determine the efficacy and adverse reaction of bleeding of the two protocols in the prevention of stroke. Methods We analyzed the incidences of stroke, bleeding and severe bleeding by using fixed-effect model or random-effect model on the basis of the result of heterogeneity test. Results Five qualified RCTs satisfied the inclusion criteria. We found that treatment with aspirin plus clopidogrel was associated with lower incidence of stroke (Risk Ratio (RR), 0.66, 95% confidence interval (CI), 0.47 to 0.93), higher incidence of bleeding (RR, 1.75, 95% CI, 1.48 to 2.05) as compared with aspirin-alone treatment. In terms of severe bleeding, no statistical difference existed between them (RR, 2.21, 95% CI, 0.25 to 19.52). Conclusion The combined use of aspirin and clopidogrel is more effective than aspirin alone for patients with previous TIA or stroke for the prevention of stroke, with risk of bleeding being higher. No statistical difference was found in severe bleeding between the two treatment protocols.
Hypercalciuria in children with urinary tract symptoms  [cached]
Fallahzadeh M,Fallahzadeh M,Mowla A,Derakhshan A
Saudi Journal of Kidney Diseases and Transplantation , 2010,
Abstract: We performed this prospective study to determine the urinary calcium to creatinine ratio (Ca/Cr) in children with different urinary symptoms. We studied 523 children in our neph-rology clinic with an age range of 3 to 14 years (mean= 8) and male to female ratio of 0.61. All the children had at least one of the urinary tract symptoms (dysuria, frequency, urgency, abdo-minal and/or flank pain, diurnal incontinence or enuresis), microscopic hematuria, urinary tract infection or urolithiasis. Fasting urine was collected for measuring calcium and creatinine and the results were compared to the values for the normal Iranian children. Ca/Cr ratio of more than 0.2 (mg/mg) was considered as hypercalciuria. Of all the patients, 166 (31.3%) were hypercalciuric. Urine Ca/Cr ratio was significantly higher in all the subgroups with one or more of the urinary symptoms (P< 0.001). We conclude that urine Ca/Cr ratio is significantly increased in children with all types of urinary symptoms. We recommend measuring urinary calcium in all children with urinary tract symptoms, especially if unexplained.
Comparative evaluation of treatment with low-dose aspirin plus dipyridamole versus aspirin only in patients with acute ischaemic stroke
Arnarsdottir Lola,Hjalmarsson Clara,Bokemark Lena,Andersson Bj?rn
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-67
Abstract: Background Previous studies have suggested that pre-stroke treatment with low-dose aspirin (A) could reduce the severity of acute ischaemic stroke, but less is known on the effect of pre-stroke treatment with a combination of aspirin and dipyridamole (A + D) and post-stroke effects of these drugs. The aim of the present study was to evaluate the effect of this drug combination on acute and long-term prognosis of ischaemic stroke. Methods Patients without atrial fibrillation admitted to the stroke unit with acute ischaemic stroke (n = 554) or TIA (n = 108) were studied during acute hospital care and up to 12 months after discharge from hospital. Results Prior to acute stroke 62 patients were treated with A + D while 247 patients were treated with A only. No beneficial effects of the combination A + D compared to A only were noted on stroke severity and/or acute in-hospital mortality. However, survival analysis by Cox-proportional hazard model demonstrated lower 12-months all-cause mortality in patients discharged with A + D (n = 275) compared with patients on A only (HR, 0.52; CI, 0.32-0.86; p = 0.011; n = 262) after adjusting for age, baseline NIHSS, previous stroke, previous myocardial infarction and type 2 diabetes. We also noted a tendency towards lower all-cause mortality at 3 months with use of A + D, but this was not statistically significant (p = 0.12). Conclusions Pre-stroke treatment with a combination of low-dose A + D does not reduce the severity of acute stroke, nor does it reduce the acute in-hospital mortality. However, treatment with A + D at discharge from hospital is seemingly associated with lower long-term mortality compared with A only, contrary to the results from previous randomised studies. However, our results must be interpreted with extreme caution considering the non-randomised study design.
Gastroprotective Effect of Rubia cordifolia Linn. on Aspirin Plus Pylorus-Ligated Ulcer
R. S. Deoda,Dinesh Kumar,S. S. Bhujbal
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1155/2011/541624
Abstract: The present study was designed to investigate the effect of Rubia cordifolia (Rubiaceae) against experimentally induced gastric ulcer and compare activity with its fractions by employing aspirin plus pylorus-ligated ulcer screening model in Wistar rats. Total acidity, volume of gastric acid secretion, total acid output, and pepsin activity show significant reduction, when compared with the control group. The present study confirmed that chloroform fraction showed the significant activity at lower doses compared to parent extract. The mechanism can be attributed to decrease in gastric acid secretary activity along with strengthening of mucosal defensive mechanism by prostaglandin synthesis and antioxidant potential.
Low Molecular Weight Heparin versus Aspirin plus Intermittent Compression Devices for Thromboprophylaxis in Indian Patients Undergoing Total Hip and Knee Arthroplasty  [PDF]
Sushil Paudel
Nepal Orthopaedic Association Journal , 2013, DOI: 10.3126/noaj.v3i2.9525
Abstract: Introduction: Thromboembolic complications is common after arthroplasty. The purpose of this study was to find out the incidences of deep vein thrombosis, symptomatic, and fatal pulmonary embolism in Indian patients undergoing arthroplasties and to compare the effectiveness and safety of thromboprophylaxis with low molecular weight heparin versus aspirin plus intermittent pneumatic compression device.
Urinary tract infections and related symptoms in patients with gynecological
Serra KAMER,?zlem AKAGüNDüZ,Zeynep ?ZSARAN,Mustafa ESASSOLAK
Turkish Journal of Oncology , 2008,
Abstract: OBJECTIVES: The purpose of this study was to evaluate the genitourinary symptoms and the risk of urinary tract infections in patients with gynecological malignancy treated with radiotherapy. METHODS: Mid-stream specimens of urine were collected and urine cultures were performed in 45 patients with gynecological malignancy; genitourinary symptoms were recorded during pelvic radiotherapy. RESULTS: Before the treatment, urinary tract infections were detected in four patients, while during the treatment seven patients had positive urine cultures. Dysuria was recorded in five patients before radiotherapy, and at the end of treatment, 40 cases experienced grade 1 or 2 dysuria. No significant relationship was detected between urinary tract infection and clinical genitourinary symptoms. CONCLUSION: The most effective method to define urinary tract infection in patients with gynecologic malignancies is urine culture during the treatment. Routine prophylactic antibiotherapy is not recommended because of the low risk of infection during radiotherapy.
COX-2: Where are we in 2003? - Specific cyclooxygenase-2 inhibitors and aspirin-exacerbated respiratory disease
Leslie J Crofford
Arthritis Research & Therapy , 2002, DOI: 10.1186/ar620
Abstract: Up to 10–20% of the general asthmatic population have hypersensitivity to aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) leading to severe exacerbation of asthma and naso-ocular reactions [1,2]. Formerly termed aspirin-sensitive asthma, these patients are now characterized as having aspirin-exacerbated respiratory disease (AERD) because they have chronic upper and lower respiratory-tract mucosal inflammation, sinusitis, nasal polyposis, and asthma independent of their hypersensitivity reactions [3]. Because essentially all traditional NSAIDs also trigger the hypersensitivity reaction, treatment of pain and inflammation has been challenging. With the introduction of drugs that specifically inhibit cyclooxygenase (COX)-2, the question of whether these agents cross-react with aspirin to cause exacerbation of asthma and rhinitis becomes clinically relevant.Eicosanoids are important mediators of bronchial reactivity and inflammation in asthma. In the asthmatic airway, arachidonic acid is metabolized to prostaglandins (PGs) and leukotrienes. PGE2 functions as a bronchodilator and can also inhibit granulocyte functions [4]. PGs are produced through an enzymatic pathway that includes the COX enzymes. Both the COX-1 and COX-2 isoforms are expressed in the respiratory epithelium (basal and ciliated cells) in normal subjects and in patients with chronic stable asthma and chronic bronchitis [5]. Epithelial COX-1 expression is not different in asthmatics with or without aspirin sensitivity and in normal subjects, whereas COX-2 expression is increased in asthmatics compared with normals but is not different in aspirin-sensitive asthmatics compared with aspirin-tolerant asthmatics [4,6]. However, COX-2-expressing inflammatory cells are increased in the submucosa of aspirin-sensitive asthmatics [6]. Furthermore, COX-2 expression is increased in airway epithelium in non-corticosteroid-treated asthmatics compared with steroid-treated asthmatics and non-asthmatic controls
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