Comparative effect of aspirin and clopidogrel on arterial function in CHF

Meune, Christophe; Mahé, Isabelle; Solal, Alain Cohen; Lévy, Bernard; Duboc, Denis; Simoneau, Guy G.; Champion, Karine; Mourad, Jean‐Jacques; Weber, Simon; Bergmann, Jean‐François

doi:10.1016/j.ijcard.2004.12.059

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…Neither weight nor plasma creatinine measurements changed significantly during the study. Combined with our previous results demonstrating an increase in peripheral arterial tone after aspirin treatment in CHF patients, these results support the concept that aspirin induces a sustained peripheral vasoconstriction which may affect filling pressure [8,19]. The clinical relevance of a 36±69 pg/ml increase (34% relative increase) in BNP levels cannot be derived from our study.…”

Section: Discussionsupporting

confidence: 86%

“…However, in one of these studies, the authors investigated the effect of ticlodipine, which is now very rarely prescribed [11], and in the second study, the authors measured peak VO 2 but only investigated the effect of a single dose of aspirin or clopidogrel [31]. Finally, in a previous study, we demonstrated a neutral effect of clopidogrel on vascular function in CHF patients using applanation tonometry, an accurate method of assessing peripheral arterial vasoconstrictor tone [19]. Thus, our current results confirm and further reinforce our previous studies by showing a differential effect on BNP, an important prognostic factor in CHF.…”

Section: Discussionmentioning

confidence: 99%

“…Based upon previous results [8,19], in order to detect a 25% relative variation in BNP measurement after aspirin treatment, with a 20% standard deviation ( α =0.05, β =0.1, bilateral test), 17 patients had to be enrolled in each group.…”

Section: Methodsmentioning

confidence: 99%

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Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors

Meune

Wahbi

Fulla

et al. 2007

European J of Heart Fail

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Background: By inhibiting prostaglandins, aspirin may be deleterious in heart failure (HF) and/or may counteract angiotensin-converting enzyme (ACE) inhibitor efficacy. Conversely, clopidogrel has no effect on prostaglandin metabolism. Aim: To investigate the effect of aspirin and clopidogrel on brain natriuretic peptide (BNP) levels in HF patients treated with ACE inhibitors. Methods: 36 patients with stable HF (65 ± 13 years, 24 males/12 females, NYHA class II to IV, ejection fraction < 40%, 13 with coronary disease, all treated with ACE inhibitors) were enrolled in this prospective, double-blind study and randomised to aspirin 325 mg/day or clopidogrel 75 mg/day for 14 days. BNP was determined at day 0 and day 14. Results: 19 patients were randomised to aspirin and 17 to clopidogrel. Baseline characteristics were similar in both groups. BNP levels increased in the aspirin group from day 0 to day 14 (107 ± 103 to 144 ± 149 pg/ml, p = 0.04) whereas clopidogrel had no effect (104 ± 107 and 97 ± 99 pg/ml respectively, p = 0.61). Conclusion: This study demonstrates an adverse effect of aspirin 325 mg/day on BNP plasma levels in HF patients treated with ACE inhibitors. In contrast clopidogrel 75 mg/day had no effect.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors

Meune

Wahbi

Fulla

et al. 2007

European J of Heart Fail

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Aspirin, clopidogrel, and warfarin use and outcomes in a cohort of 580 patients discharged after hospitalization for decompensated heart failure

et al. 2011

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The benefits of taking of aspirin, clopidogrel, and warfarin in relation to cardiovascular mortality and re-hospitalization in chronic heart failure (HF) patients have been called into question. We examined the outcomes (cardiac mortality and/or HF re-hospitalization) in patients discharged from our hospital between January 2003 and July 2009 after hospitalization for chronic decompensated HF. Of 580 HF patients (mean age, 63 ± 13 years; mean ejection fraction, 26 ± 9%, 63% with coronary disease and 37% without coronary disease), 207 patients (36%) died due to cardiovascular reasons, and 313 (54%) required HF re-hospitalization for decompensated HF during a 39 ± 14 month follow-up period. 101 (17%) patients were taking clopidogrel during enrollment in the study. When comparing patients who were on clopidogrel treatment with those who were not, clopidogrel was found to have a beneficial effect on cardiac mortality (27 vs. 38%, P = 0.04). In conclusion, in this observational prospective study, patients who used clopidogrel showed decreased cardiac mortality [HR, 0.566 (95% CI 0.332-0.964), P = 0.036] compared to patients who did not take clopidogrel. Clopidogrel had a beneficial effect on the survival of chronic HF patients in the long term.

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Role of Antithrombotic Agents in Heart Failure

2012

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Despite a vast body of research on antithrombotic therapy for patients with cardiac disease, there are few clinical settings where robust evidence of their benefit exists. Patients with heart failure often have vascular disease and atrial fibrillation contributing to their poor prognosis. For patients with heart failure and atrial fibrillation, anticoagulants are appropriate. For patients with heart failure in sinus rhythm, the weight of evidence suggests that doctors should generally avoid using any antithrombotic agent even if the patient has coronary artery disease. If there is a compulsion to treat, then there is less evidence of harm with clopidogrel or warfarin than with aspirin, although most receive aspirin. More research is required for this "evidence-light" problem. For those with the opportunity, engaging with a randomized trial is clinically and scientifically appropriate. The dilemma for such studies is the comparator. Should it be against or in addition to "standard of care" or both?

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Comparative effect of aspirin and clopidogrel on arterial function in CHF

Cited by 7 publications

References 38 publications

Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors

Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors

Aspirin, clopidogrel, and warfarin use and outcomes in a cohort of 580 patients discharged after hospitalization for decompensated heart failure

Role of Antithrombotic Agents in Heart Failure

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