Clinical Applications of Aspirin as a Multi-potent Drug Beyond Cardiovascular Implications: A Proof of Concept for Anesthesiologists- A Narrative Review

Rezabakhsh, Aysa; Imani, Farnad; Mahmoodpoor, Ata; Soleimanpour, Maryam; Shahsavarinia, Kavous; Soleimanpour, Hassan

doi:10.5812/aapm.118909

Cited by 10 publications

(8 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent meta-analysis, propofol-based IV anesthesia improved both cancer-free survival and overall survival (68). Further, COX inhibitors have also shown promise in persevering cancer immune function (69). Ketorolac can potentially reverse the NKcell cytotoxicity compared to morphine (70).…”

Section: Propofol Paravertebral Block and Nsaids: Techniques Of Promise?mentioning

confidence: 99%

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

et al. 2022

View full text Add to dashboard Cite

: The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.

show abstract

Section: Propofol Paravertebral Block and Nsaids: Techniques Of Promise?mentioning

confidence: 99%

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

et al. 2022

View full text Add to dashboard Cite

show abstract

“…continuously in nucleated cells, stimuli for in ammation increase the expression of COX-2 10 to 20-fold in nucleated cells. Because atherosclerosis is an in ammatory disease, increased COX-2 overexpression may lead to aspirin resistance in patients with ischemic heart disease [16].…”

Section: R E S U L T Smentioning

confidence: 99%

High Risk of Cardiovascular Events in Patients, Biosynthesis of Aspirin-Resistant Thromboxane And The Risk Of Stroke, Myocardial Infarction Or Death

Rehman¹,

Shah

Nabi

et al. 2022

PBMJ

View full text Add to dashboard Cite

In a higher-risk group, we investigated if aspirin resistance, which is defined as inability to reduce production of thromboxane, enhanced the risk for cardiovascular disease. Methods: The Cardiac Outcome Preventive Assessment Study collected baseline urine samples from 5000 patients. A level of urinary 11-dehydro-thromboxane B2 was measured, which is a marker of within vitro cell generation of thromboxane, in 400 cured patients with aspirin having a cardiovascular death, stroke and infarction, stroke during a 5-year follow-up and in 400 age - and matching sex control subjects, which did not have an event, using a nested case-control design. Result: After accounting for baseline differences, the risks of infarction, strokes, or cardiac mortality rose with every fourth of 11-dihydro-thromboxane B2, with individuals in the top fourth section having a 1.9-fold greater threat than those from the lower portion (“OR, 1.9; 95% CI, 1.3 to 2.8; p=0.009). The upper quartile showed a 2-fold increased myocardial infarction risk ("OR, 2.1; 95% CI, 1.3 to 3.5; p=0.07) and a 3.6-fold elevated risk of cardiac death ("OR, 3.6; 95% CI, 1.78to 7.5; p=0.01) than the lower quartile. Conclusions: the 11-dehydro thromboxane B2 level in urine, better determine the risk of cardiovascular events or cardiovascular death in aspirin-treated patients. These findings also depicts that patients with elevated urine 11-dehydro thromboxane B2 concentrations are more impervious to aspirin, and could profit from greater antiplatelet medications or therapies that even more efficiently stop thromboxane generation in vivo or activities.

show abstract

“…While NSAIDs are generally safe and well-tolerated, their side-effect profiles limit their use, particularly when used long-term or when high doses are required to control pain ( 13 ). The side effects include gastrointestinal ulceration and bleeding, renal insufficiency, coronary heart disease, and thrombotic cardiovascular events ( 14 , 15 ).…”

Section: Evidence Acquisitionmentioning

confidence: 99%

Conolidine: A Novel Plant Extract for Chronic Pain

et al. 2021

View full text Add to dashboard Cite

: Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3’s inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.

show abstract

Clinical Applications of Aspirin as a Multi-potent Drug Beyond Cardiovascular Implications: A Proof of Concept for Anesthesiologists- A Narrative Review

Cited by 10 publications

References 105 publications

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

High Risk of Cardiovascular Events in Patients, Biosynthesis of Aspirin-Resistant Thromboxane And The Risk Of Stroke, Myocardial Infarction Or Death

Conolidine: A Novel Plant Extract for Chronic Pain

Contact Info

Product

Resources

About