Randomized comparative trial of triflusal and aspirin following acute myocardial infarction

SummaryTriflusal is a derivative of acetylsalicylic acid but it exhibits different pharmacological and pharmacokinetic properties. The object of this study was to evaluate the efficacy of additional use of triflusal in patients who underwent drug-eluting stent implantation.First, we prospectively tested platelet function with a rapid platelet function analyzer (VerifyNow Ⓡ -Aspirin) in patients with stable angina (male, age, 61.6 ± 8.3, body weight, 69.3 ± 11.2 kg) who maintained dual (aspirin 100 mg and clopidogrel 75 mg per day, n = 23) or triple (aspirin 100 mg, clopidogrel 75 mg, and triflusal 300 mg per day, n = 23) therapy for more than one month. They were randomly assigned to a group. The triple group showed superior inhibition of arachidonic acid induced platelet aggregation compared to the dual group (420.2 ± 47.7 ARU versus 465.0 ± 71.2 ARU, P = 0.016). Second, we compared composite outcomes (death, myocardial infarction, and nonhemorrhagic stroke) after drug-eluting stent (DES) implantation between the dual (n = 1474) and triple (n = 433) groups in the prospective Seoul National University Hospital drug-eluting stent (SNUH-DES) cohort. The triple group had more current smokers, male patients, and patients with a previous history of revascularization. Also, the triple group underwent more complex interventions such as left main, chronic total occlusion, long lesion, and restenotic lesion than the dual group. In spite of their higher risk profiles, the triple group patients showed comparable composite outcomes (19 cases, 4.4%) to those of the dual group ones (41 cases, 2.8%) (P = 0.12). The triflusal-based triple antiplatelet therapy achieved superior platelet inhibition compared to the dual therapy ex vivo and it could be applied after complex intervention with DES. (Int Heart J 2009; 50: 701-709)

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“…13,14) These pleiotropic beneficial aspects of triflusal would lead to better laboratory and clinical outcomes in patients treated with DES.…”

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confidence: 99%

Comparison of Triple Antiplatelet Therapy Including Triflusal and Conventional Dual Therapy in Patients Who Underwent Drug-Eluting Stent Implantation

et al. 2009

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“…6 In major clinical trials, Triflusal has demonstrated efficacy similar to aspirin in the secondary prevention of ischemic episodes but with a markedly reduced risk of cerebral and systemic hemorrhage. 7 Recently, it has been demonstrated that Triflusal and HTB are potent in vitro and in vivo inhibitors of the activation of NF-B and NF-B-regulated genes. Furthermore, orally administered Triflusal is neuroprotective and downregulates NF-B, inflammatory mediators, and microglial activation in an excitotoxic (N-methyl-D-aspartate) injury model in the postnatal rat brain.…”

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Interaction Between a Rat Model of Cerebral Ischemia and β-Amyloid Toxicity

Whitehead

Cheng

Hachinski

et al. 2005

Stroke

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Background and Purpose-Clinical data suggest that Alzheimer disease (AD) and stroke together potentiate cognitive impairment. Our rat model demonstrates that this interaction may be mediated through inflammatory cells and pathways. Thus, anti-inflammatory agents such as Triflusal, a nonsteroidal anti-inflammatory agent (NSAID), may provide neuroprotection for susceptible neurons in AD and cerebral ischemia. Methods-AD was modeled by cerebroventricular injections of ␤-amyloid (A␤25-35) and subcortical lacunar infarcts by striatal endothelin injections. Inflammatory mechanisms were examined by immunohistochemical analysis. Behavioral tasks were assessed with the Montoya staircase test. Results-Triflusal reduced pathologic and inflammatory markers and functional deficits in rats receiving A␤ or endothelin alone but was less effective in the more severe pathology of the combined A␤/endothelin model. Conclusions-Higher doses or more prolonged treatment with NSAIDs may be required for more effective neuroprotection in combined AD and stroke conditions. (Stroke. 2005;36:1782-1789.)

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“…Moreover, patients treated with triflusal had a lower risk of hemorrhage than those treated with ASA (14,15,42,46). Triflusal was associated with significantly fewer episodes of cerebral hemorrhage (0.3% in patients treated with triflusal vs. 1.0% in patients treated with ASA), and the reduction was also evident in patients who received fibrinolytic therapy (14). The administration of triflusal was associated with a significantly lower risk of severe hemorrhage in comparison to acenocoumarol (INR 2-3) or to combination of the two drugs (INR 1.25-2.4); the incidence of this event was 0.4, 1.8, and 0.9%, respectively, for each treatment (46).…”

Section: Adverse Reactionsmentioning

confidence: 99%

“…Two trials (the TACIP and TAPIRSS studies) involved patients with cerebral infarction (15,42), one trial (the NASPEAF study) studied triflusal in thromboprophylaxis for atrial fibrillation (46) and one (the TIM study) involved patients with myocardial infarction (14). The meta-analysis included clinical trials in patients with stroke and myocardial infarction (13).…”

Section: Adverse Reactionsmentioning

confidence: 99%

“…This makes it important to consider the possible interactions between drugs. Unlike ASA, triflusal is less likely to interfere with the efficacy of antihypertensive drugs (42), especially ACE inhibitors (14,28). However, HTB interacts with serum protein binding of various drugs to the same degree as ASA, so that precautions must be taken when trifusal is used in combination with anticoagulants (43,44).…”

Section: Adverse Reactionsmentioning

confidence: 99%

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Triflusal: An Antiplatelet Drug with a Neuroprotective Effect?

González-Correa

Cruz

2006

Cardiovasc Drug Reviews

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Triflusal is a derivative of salicylic acid with a well-established platelet aggregation inhibitory profile. Its pharmacokinetic and pharmacodynamic properties differ, however, somewhat from those of acetylsalicylic acid. A number of recent experimental and clinical studies have shown that triflusal is a potentially useful choice in the treatment and prophylaxis of brain ischemia because of its antithrombogenic as well as neuroprotective effects. Its antithrombogenic effect has been demonstrated at the clinical as well as at the experimental level, while its neuroprotective effect has been shown only in experimental models. The drug interferes with thrombogenesis by inhibiting thromboxane synthesis and increasing the levels of cAMP and nitric oxide. Its neuroprotective action is the result of its antioxidant and antiinflammatory effects in brain tissue. From a clinical standpoint triflusal is similar in efficacy to acetylsalicylic acid in preventing stroke, but has less adverse effects, especially it is less likely to cause bleeding. Because of its pharmacodynamic properties and lower rate of adverse reactions, triflusal may be a useful alternative to acetylsalicylic acid in the prevention of stroke.

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Randomized comparative trial of triflusal and aspirin following acute myocardial infarction

Abstract: Triflusal and aspirin have similar efficacy in preventing further cardiovascular events after acute myocardial infarction, but triflusal showed a more favourable safety profile. Triflusal significantly reduced the incidence of non-fatal cerebrovascular events compared with aspirin.

Cited by 70 publications

References 15 publications

Comparison of Triple Antiplatelet Therapy Including Triflusal and Conventional Dual Therapy in Patients Who Underwent Drug-Eluting Stent Implantation

Comparison of Triple Antiplatelet Therapy Including Triflusal and Conventional Dual Therapy in Patients Who Underwent Drug-Eluting Stent Implantation

Interaction Between a Rat Model of Cerebral Ischemia and β-Amyloid Toxicity

Triflusal: An Antiplatelet Drug with a Neuroprotective Effect?

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