Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

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1 The gastric mucosa of portal hypertensive rats exhibits important microvascular changes and a nitric oxide (NO)-dependent hyperemia. This study analyses whether portal hypertensive mucosa exhibits changes in its ability to withstand aggression. 2 Portal hypertension was induced by partial portal vein ligation (PPVL) or common bile duct ligation (CBDL) and gastric damage was induced by oral administration of ethanol or aspirin. Experiments were performed in conscious or anaesthetized rats and some animals were pre-treated with the NO-synthesis inhibitor L-NAME. 3 Conscious PPVL or CBDL rats showed an increased resistance to the damaging eects of ethanol. Oral administration of aspirin produced less gastric damage in PPVL conscious rats than in the control group. 4 The protective eects of portal hypertension were maintained in animals anaesthetized with ketamine and absent when pentobarbital was employed. 5 Pre-treatment with L-NAME restored the damaging eects of ethanol and aspirin in PPVL rats without modifying the level of damage in control animals. 6 Gastric bleeding induced by oral aspirin, as measured by the luminal release of 51 Cr-labelled erythrocytes, was signi®cantly greater in PPVL rats than in control animals. 7 Semi-quantitiative analysis by RT ± PCR of the mRNA for endothelial NO-synthase (eNOS), neuronal NOS (nNOS) and inducible NOS (iNOS) levels showed that the expression of iNOS was slightly increased in both the gastric mucosa and smooth muscle of PPVL rats. No changes were observed in eNOS and nNOS expression. 8 Conscious portal hypertensive rats exhibit an enhanced resistance to acute gastric damage which is absent under the in¯uence of some types of anaesthesia and seems related to an increased synthesis of nitric oxide. However, mucosal lesions in these animals show an augmented bleeding per area of injury.

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