Clinical Use of Aspirin in Ischemic Heart Disease: Past, Present and Future

Abstract

Aspirin is an antiplatelet drug, inhibiting the cyclooxygenase activity of platelet prostaglandin H synthase-1 and almost complete suppressing platelet capacity to generate the prothrombotic and proatherogenic thromboxane A2. Antiplatelet therapy with aspirin reduces the risk of serious vascular events by about a quarter in patients who are at high risk because they already have occlusive vascular disease. However, the inhibition of thromboxane-dependent platelet function by aspirin is effective for the prevention of thrombosis, but is also associated with excess bleeding, although the absolute increase in major gastrointestinal or other major extracranial bleeds is an order of magnitude smaller. For secondary prevention of vascular events, the benefits of aspirin therapy substantially exceed the risks. Therefore, aspirin is a cornerstone of antithrombotic therapy in acute coronary syndromes, in chronic ischemic heart disease and in percutaneous coronary intervention. On the other hand, the role of aspirin in primary prevention remains uncertain and it is still debated, because the absolute risk of vascular complications is the major determinant of the absolute benefit of antiplatelet prophylaxis and the reduction in vascular events needs to be weighed against any increase in major bleeds. Future data from ongoing studies will help us to identify people at high vascular risk who take advantage from aspirin therapy for primary prevention or will indicate if specific category of high risk patients, like patients with diabetes, could be better protected from an increase in the frequency of aspirin administration.

Antithrombotic Effect of Artemisia princeps Pampanini Extracts in Vitro and in FeCl3‐Induced Thrombosis Rats

“…Aspirin decreases platelet aggregation, inactivating the cyclooxygenase (COX) activity of prostaglandin (PGH)-synthase-1 and PGH synthase-2 (also referred to as COX-1 and COX-2) (De Caterina & Renda, 2012). These enzymes catalyze the change of arachidonate to prostaglandin H 2 (PGH 2 ), which is the precursor of TXA 2 and PGI 2 (Del Gaudio et al, 2013).…”

Role of Antiplatelet Therapies in Preventing Atherothrombosis

“…The beneficial efficacy of aspirin for primary prevention of vascular thrombosis is counterbalanced by hazards of excess bleeding, which has resulted in critically selecting subjects at increased risk of thrombosis for prevention after considerable evaluation for the existing risk of bleeding [40,41]. Conversely, the benefits of aspirin for secondary prevention clearly outweigh the risks of bleeding, thus aspirin continues to be fundamental of antithrombotic therapy as secondary prevention in coronary, cerebral as well as peripheral vascular thrombotic events.…”

Preparation and activity of glycosylated acetylsalicylic acid

“…We all know that this medicine can be used to treat colds, fever, headaches, toothache, joint pain, and rheumatism. It also can inhibit platelet aggregation, prevent and treat ischemic heart disease, cardiopulmonary infarction, cerebral thrombosis and other diseases (De and Renda, 2012). In addition, it has shown that acetylsalicylic acid has anti-cancer effect (Rothwell et al, 2012).…”