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To determine the extent of which acetyl salicylic acid (ASA) use is included in patients' pharmacy records. During an in-home interview, people aged ≥ 65 years were asked to report all of the medications they had used at least once, including over-the-counter drugs, during the preceding month. Researchers recorded information on the drug name, reason for its use, and whether a physician prescribed it. From the pharmacy records, the drug names, prescription fill dates, quantities supplied, and the numbers of days' supply were recorded. The level of agreement for ASA use across data sources was assessed using proportions of agreement and kappa coefficients. Of 193 individuals interviewed, 86 reported the use of ASA, including 76 ASA users (88.4%) who said it was prescribed by a physician. Pharmacy medication records indicated that there were 74 users of ASA. The proportion of agreement for ASA use was 93.8%, and kappa coefficient was 0.87 (95% confidence interval: 0.80-0.94). The sensitivity, specificity, and positive predictive value of the pharmacy data were all high. A large proportion of ASA use is documented in pharmacy records in Quebec. Thus, the information regarding ASA use in pharmacy records is reliable. This result may not be reproducible in other settings where pharmaceutical reimbursement rules are different.

We studied the effects of a new regimen consisting of intravenous immune globulin (IVIG) combined with dexamethasone (DEX) on clinical outcome and serum levels of vascular endothelial growth factor (VEGF) in the initial treatment of Kawasaki disease (KD). A total of 46 KD patients received 0.3 mg/kg per day DEX plus heparin i.v. for 3 consecutive days, together with 2 g/kg IVIG over 4 to 5 days (DEX group). Low-dose acetylsalicylic acid was started after completion of DEX therapy. The control group consisted of 46 KD patients retrospectively treated earlier with 2 g/kg IVIG over 4 to 5 days plus higher dose acetylsalicylic acid (CONTROL group). No serious adverse effect was noted in either group. There were no differences in baseline and post-treatment laboratory data except for C-reactive protein between the groups. Post-treatment C-reactive protein in the DEX group (median 0.9 mg/dl, range 0.0 to 24.7 mg/dl) was lower than that (1.2 mg/dl, range 0.2 to 19.5 mg/dl) in the CONTROL group ( P=0.033 by Mann-Whitney U test). In addition, the mean duration of fever after the first IVIG infusion was 2.2 days (median 1 day, range 1 to 12 days) in the DEX group and 2.8 days (2 days, 1 to 16 days) in the CONTROL group ( P=0.015 by Mann-Whitney U test). The new regimen did not reduce VEGF levels. Two patients in each group developed small- or medium-sized coronary artery aneurysms. Although this regimen did not affect coronary outcome, intravenous immune globulin therapy combined with dexamethasone for the initial treatment of Kawasaki disease was safe and may accelerate the resolution of systemic inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) possess antipyretic, analgesic and anti-inflammatory effects. They are frequently used in children and have numerous therapeutic indications, the most common ones being fever, postoperative pain and inflammatory disorders, such as juvenile idiopathic arthritis (JIA) and Kawasaki disease. Their major mechanism of action is through inhibition of prostaglandin biosynthesis by blockade of cyclo-oxygenase (COX). The disposition of most NSAIDs has been mainly studied in infants > or = 2 years of age. Compared with adults, the volume of distribution and clearance of NSAIDs such as diclofenac, ibuprofen (infants aged between 3 months and 2.5 years), ketorolac and nimesulide were increased in children. The elimination half-life was similar in children to that in adults. These pharmacokinetic differences might be clinically significant with the need for higher loading and/or maintenance doses in children. Ibuprofen, acetylsalicylic acid (ASA) and acetaminophen are the most frequently used agents for fever reduction in children. Over the past 20 years, because of the association between ASA use and Reye's syndrome, most of the interest has been directed toward ibuprofen and acetaminophen. In view of its comparable antipyretic efficacy, but superior tolerability profile, acetaminophen, when used appropriately with age-adapted formulations, should remain the first-line therapy in the treatment of childhood fever. At the moment, there is no scientific evidence to recommend simultaneous use of these two antipyretic drugs. Most NSAIDs provide mild to moderate analgesia, with the exception of ketorolac which has a strong analgesic activity. The analgesic efficacy of ketorolac, ketoprofen, diclofenac and ibuprofen in the treatment of postoperative pain has been mainly studied following a single dose, in children of > or = 1 year of age undergoing minor surgeries. In this setting, when used either alone or in adjunct to caudal or epidural anaesthesia, they were associated with an opioid-sparing effect and were well tolerated. With the exception of ketorolac use in children undergoing tonsillectomy, where controversy exists regarding the risk of postoperative haemorrhage, NSAIDs have not been associated with an increased risk of perioperative bleeding. NSAIDs are the first-line therapy in JIA. They appear to be equally effective and tolerated, with the exception of ASA which is associated with more adverse effects. ASA has been used for many years in the treatment of Kawasaki disease and is part of the standard modality of treatment in combination with intravenous gammaglobulins. More recently, lung inflammation associated with cystic fibrosis (CF) has become a new target for NSAIDs. Despite promising preliminary results with ibuprofen, numerous questions need to be answered before this new strategy becomes part of the conventional treatment of patients with CF. In summary, NSAIDs are effective in reducing fever, alleviating pain and reducing inflammation in children, with a good tolerance profile. Pharmacokinetic studies are needed to characterise the disposition of NSAIDs in very young infants in order to use them rationally. To date, no studies have been published on the disposition, tolerability and efficacy of specific COX-2 inhibitors in children. Further clinical experience with these agents in adults is warranted before undergoing trials with specific COX-2 inhibitors in children.

Low-dose acetylsalicylic acid (ASA) is given to most patients with polycythemia vera (PV) and essential thrombocythemia (ET) although some uncertainties encompass this clinical practice. In patients with history of thrombosis, the use of ASA is supported on the results observed in the general population showing a substantial net benefit of this treatment in preventing thrombosis. In the European collaboration study on low-dose aspirin in polycythemia vera (ECLAP), ASA reduced the risk of thrombosis without increasing the risk of major bleeding when compared with placebo, supporting the primary prevention of thrombosis in PV. In ET, the efficacy of low-dose ASA has not been tested in randomized clinical trials. Two retrospective studies have shown that low-dose ASA could benefit ET patients older than 60 years when combined with cytoreduction, whereas in young, low-risk patients, ASA benefits to particular subgroups of patients. In spite of the fact that in primary myelofibrosis the incidence of thrombosis is increased, the use of ASA is not clearly recommended.

Background: Several studies have assessed the effects of acetylsalicylic acid (ASA), a widely used drug worldwide, in non-alcoholic fatty liver disease (NAFLD) patients. In this systematic review, we aim to evaluate the effect of ASA use on the prevalence of NAFLD, as well as hepatic steatosis and fibrosis in NAFLD patients. Methods: We performed a systematic search on PubMed and Embase electronic databases with predefined keywords searching for observational and experimental studies published from inception and till 19 July 2019. The diagnosis of NAFLD was based on histology, imaging or surrogate markers. Eligible articles based on inclusion and exclusion criteria were extracted and included in the qualitative assessment using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. Results: A total of seven observational studies (5 cross-sectional and 2 cohort) were included involving 18,209 subjects. Three studies evaluated the prevalence of NAFLD in subjects receiving ASA, out of which two studies demonstrated a lower prevalence rate in subjects using ASA for at least ≥ 15 times per month. On the other hand, only one study demonstrated no prevalence decrease in NAFLD with the use of ASA. Moreover, hepatic steatosis and fibrosis was evaluated in four studies with histological confirmation of NAFLD. Two of these studies reported a reduced severity of hepatic steatosis with ASA use. On the other hand, a study demonstrated that a less severe hepatic steatosis but not histological improvement was associated with ASA use. Furthermore, another study reported that ASA use in type 2 diabetic patients wasn’t associated with protective effects against advanced hepatic fibrosis. Statistical pooling of included studies wasn’t performed due to heterogeneity of the study designs. Conclusions: Although most studies demonstrated potential protective effects of ASA use in hepatic steatosis and fibrosis, as well as a reduced prevalence of NAFLD, results from the current literature remain inconsistent with the quality of most studies being rated as fair or poor. Therefore, clear conclusions and recommendations can’t be drawn from the current studies in the literature evaluating this association. Further experimental studies are required to confirm the potential protective effects associated with ASA use on NAFLD. ​

Objective To analyze the clinical effect of gamma globulin combined with aspirin in the treatment of children with Kawasaki disease. Methods Fifty children with Kawasaki disease treated in Liaocheng People’s Hospital from March 2017 to October 2018 were randomly collected. The children were divided into control group and observation group, with 25 cases in each group. The control group was treated with routine dose of aspirin and the observation group with high dose of aspirin. Results The clinical effective rate in the observation group was higher than that in the control group, and the incidence of cardiovascular complications was lower than that in the control group, and the difference was statistically significant (P< 0.05). The main symptoms such as fever, lymphadenopathy, mucosal congestion, hand and foot swelling and other main symptoms disappeared and hospitalization time were significantly shorter than those in the control group (P< 0. 05). After treatment, the CRP, WBC, PLT of the children in the observation group was significantly shorter than that in the control group (P< 0.05). The level of PCT was significantly lower than those of control group (P< 0.05). Conclusions The effect of gamma globulin (high dose) plus aspirin in the treatment of children with Kawasaki disease is reliable.It has good safety and generlized value. Key words: Kawasaki disease; Aspirin; Gamma globulin

Cardiovascular disease (CVD) is a major cause of death among patients with diabetes. Antiplatelet therapy is an important part of the treatment and prevention of CVD and acetylsalicylic acid (ASA) is the main medication. This review describes modern approaches to the primary prevention of cardiovascular events in patients with diabetes. Until now, no concerted strategy on this issue has been developed by the global medical communities. The approaches used in the guidelines were heterogeneous and did not cover most of the risk factors, which were often associated with the underlying disease. The risk assessment for CVD with a view to developing risk factor stratification is often difficult due to the variety of manifestations and complications of the disease, as well as the specificity of factors used as independent predictors of atherosclerotic vascular disease for the diabetes population. Only cardiovascular risk analysis in an individual patient can make it possible to choose the best method for prevention. Therefore, the most important objective is to introduce the adopted CVD risk stratification criteria for patients with diabetes into clinical practice, which will enhance the preventive treatment and personalize the therapeutic approaches. The adopted standardized cardiovascular risk analysis system for patients with diabetes, for now, has been implemented in the 2019 European clinical guidelines. The consensus regarding use of ASA adopted by the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) in 2019 has been based on meta-analyses with a high degree of evidence. They advise to use low-dose ASA in patients with diabetes, if they are at «high» and «very high» risk of CVD and have no obvious contraindications. It allowed clinicians to use low-dose ASA (in combination with proton pump inhibitors) as one of the most important methods for primary prevention. Such modern approaches will surely improve the cardiovascular morbidity and mortality rates in the diabetes population.

BackgroundCardiovascular agents, including angiotensin-converting enzyme inhibitors, angiotensin II receptor inhibitors, acetylsalicylic acid, statins, and metformin, have demonstrated benefits for depression. However, there is scant evaluation of these drugs’ antidepressant properties in large population settings.ObjectiveThis study aimed to examine cross-sectional associations between depression symptoms and the use of cardiovascular agents and metformin in populations with cardiovascular diseases or diabetes mellitus.MethodsParticipants in the Trøndelag Health Study 2006–08 (HUNT3, n = 40,516) and 2017–19 (HUNT4, n = 42,103) were included and data on their drug use from 2006 to 2019 was retrieved from the Norwegian Prescription Database. The outcome was self-reported depression symptoms defined by the Hospital Anxiety and Depression Scale. Associations between cardiovascular agents or metformin use and self-reported depression were analyzed by multi-level logistic regression in sex-stratified samples.ResultsAmong men with cardiovascular diseases, use of acetylsalicylic acid was associated with reduced depression symptoms compared with acetylsalicylic acid non-users (reference) in HUNT3 and HUNT4 [risk ratio = 0.76; 95% confidence interval 0.59–0.94, risk ratio = 0.67; 95% CI 0.52–0.82, respectively]. Similarly, male statin users had a lower likelihood of reporting depression than statin non-users in HUNT3 (risk ratio = 0.70; 95% confidence interval 0.54–0.86) and HUNT4 (risk ratio = 0.67; 95% confidence interval 0.51–0.84). Associations between statins or acetylsalicylic acid use and reduced depression symptoms were detected in women with cardiovascular diseases in HUNT4. We found no statistical support for associations between other cardiovascular agents or metformin use and a reduced or increased depression symptom risk.ConclusionsResults suggest negative associations between acetylsalicylic acid or statin use and depression symptoms. However, longitudinal cohort studies and randomized controlled trials are required to confirm the antidepressant effects of these drugs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-022-00321-7.

The role of non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid in the occurrence of diverticular bleeding (DB), complicated diverticulitis (CD), and acute diverticulitis (AD) is not yet defined. Update a systematic review and meta-analyses of case-control and cohort studies to evaluate the association between NSAIDs or acetylsalicylic acid with DB, CD, or AD. The study included were identified through MEDLINE, Scopus, Web of Science, and Cochrane Library databases. Sizes were pooled across studies to obtain the overall effect size. A random-effects model was used to account for different sources of variation among studies. Odds ratio (OR) with 95% confidence interval (CI) was used as a measure of effect size. Thirteen studies were included in the systematic review and meta-analysis. NSAIDs and acetylsalicylic acid use were associated with an increased risk of DB (OR: 6.90, 95% CI 3.86 to 12.35, P ˂ 0.00001, and OR 2.84, 95% CI 2.19 to 3.67, P < 0.00001, respectively). NSAIDs and acetylsalicylic acid use were also associated with increased risk of CD occurrence (OR 3.13, 95% CI 1.73 to 5.68, P = 0.0002, and OR 1.49, 95% CI 1.02 to 2.17, P = 0.04, respectively). The only study found about AD occurrence showed that NSAIDs use was not associated with AD and acetylsalicylic acid use had a low risk of AD. NSAIDs and acetylsalicylic acid significantly increase the risk of DB and CD. Further studies are needed to clarify the role of NSAIDs and acetylsalicylic acid in AD. However, increasing evidence suggests caution in the use of such medications in patients with colonic diverticula.

Introduction: Since the 1980s, the primary treatment of acute Kawasaki disease (KD) has been intravenous immunoglobulin and aspirin. However, 5 – 10% of children with acute KD will develop coronary artery abnormalities despite treatment within the first 10 days after fever onset. There is no approved adjunctive therapy to prevent progression of coronary artery damage in these patients.Areas covered: The rationale and study design of a Phase I/IIa trial of atorvastatin in children with acute KD and coronary artery inflammation is presented. The studies of host genetics and KD pathogenesis leading up to this trial are reviewed.Expert opinion: The repurposing of well-studied drugs used in the adult population is a cost-effective and efficient strategy to identify new therapies for pediatric diseases. Exploiting the anti-inflammatory, non-lipid-lowering effects of statins may open up new applications for this class of drugs for the pediatric age group.

The use of acetylsalicylic acid (ASA) is problematic in subjects with histories of hypersensitivity reactions (HRs) to it or with cross-reactive types of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We sought to evaluate the efficacy of low-dose ASA challenge (LDAC) and desensitization to allow ASA therapy at an antiplatelet dose in patients with atherosclerotic cardiovascular disease (ASCVD) or multiple related risk factors and histories of HRs to ASA or ≥ 2 chemically unrelated NSAIDs. We studied prospectively all patients with such histories and ≥ 3 risk factors for ASCVD (group I), chronic coronary syndrome (CCS, group II), and acute coronary syndrome (ACS) with indication for ASA desensitization (group III). Patients from groups I and II underwent LDACs (cumulative dose of 110mg), while those from group III were desensitized (cumulative dose of 100.1mg). We evaluated 103 patients: 62 from group I, 24 from group II, and 17 from group III. Eighty-two of the 86 patients from the first two groups underwent LDACs and 2 reacted. Subsequently, 22 (27.5%) of the 80 patients with negative LDACs were administered dual antiplatelet therapy with ASA after successful percutaneous coronary interventions, thus sparing desensitizations. The remaining 4 patients with CCS and all 17 patients from group III were successfully desensitized. In this pragmatic study,LDAC proved to be a safe and reliable diagnostic tool for identifying patients with histories of HRs to ASA or ≥ 2 different NSAIDs who can tolerate ASA at antiplatelet doses. Routine LDAC is advisable in all patients at high risk for ASCVD or with CCS who report HRs to ASA or ≥ 2 NSAIDs. ASA desensitization remains a safe and effective option in patients with ACS. Study flow-chart. ASCVD atherosclerotic cardiovascular disease; CCS chronic coronary syndrome; ACS acute coronary syndrome; ASA acetylsalicylic acid; DAPT dual antiplatelet therapy; PCI percutaneous coronary intervention; NSAIDs nonsteroidal anti-inflammatory drugs; NERD NSAID-exacerbated respiratory disease; NECD NSAID-exacerbated cutaneous disease; NIUAA NSAID-induced urticaria-angioedema or anaphylaxis; SNIUAA single NSAID-induced urticaria-angioedema or anaphylaxis; SNIDHR single NSAID-induced delayed hypersensitivity reaction.

Systemic lupus erythematosus (SLE) is a life-threatening disorder that affects women at reproductive age. We evaluate the clinical impact of pregnancy in a cohort of Portuguese SLE patients and the risk factors associated with maternal and fetal adverse outcomes. A retrospective observational study that included all pregnant women with SLE managed at a Portuguese tertiary hospital, between January 1993 and December 2019. Baseline maternal information was collected, and maternal-fetal and neonatal outcomes were evaluated. Disease activity before and during pregnancy was assessed. We included 215 pregnancies from 143 patients. Lupus nephritis was present in 20.0% and antiphospholipid syndrome (APS) in 21.9% of the cases. Preconception consultation was performed in 86.9% of the pregnancies, and 92.5% of the patients had no or low disease activity at conception. During gestation, 79.6% of the patients were under treatment, and hydroxychloroquine (HCQ) was the most commonly used drug (63.7%). Low-dose acetylsalicylic acid (ASA) was prescribed at conception in 87.9% of the patients. The live birth rate was 84.2%. An adverse pregnancy outcome (APO) occurred in 41.4% of the pregnancies. A miscarriage rate of 15.3% and a preterm delivery rate of 15.4% were found. Preeclampsia and fetal growth restriction complicated 13.1% and 14.0% of the gestations, respectively. Neonatal lupus occurred in 7.1% of the newborns, and there were 2 cases of congenital heart block. Significant risk factors for the development of AOP were disease activity at conception, lupus flare, hypocomplementemia, positivity for lupus anticoagulant, and APS. The use of ASA was significantly associated with a reduced incidence of miscarriage. An SLE flare was diagnosed in 16.3% of the cases. We identified as risk factors for lupus flares the presence of active disease at conception, a previous history of lupus nephritis, and the use of chronic medication. HCQ use during pregnancy was associated with a significant reduction of flare incidence during pregnancy and postpartum. Pregnancy in an SLE patient is associated with an increased incidence of adverse obstetric outcomes. Good disease control before pregnancy and adequate treatment, especially with HCQ, is crucial to achieving the best obstetric results.

Background: In Italy, workplace safety regulations require the training of first-aid officers to manage medical emergencies, including acute coronary syndromes. Although clinical guidelines recommend the early use of acetylsalicylic acid in myocardial infarction, little is known about the implementation of this recommendation in practice. This study aims to assess the use of acetylsalicylic acid for ST-elevation myocardial infarction (STEMI) in workplace and non-workplace settings, with a focus on informing the evaluation and improvement of first-aid training programs and emergency response protocols. Methods: We conducted a retrospective, observational cohort study using 2019 data from the Regional Agency for Emergency Urgency. Cases were identified and stratified by event location (workplace vs non-workplace), to analyze patterns of acetylsalicylic acid administration. A logic model has been developed to program a stepwise plan of action for policies development. Results: A total of 2174 STEMI cases were identified, of which 380 (17.5%) occurred in the workplace. Workplace cases were younger and more likely to be male. Acetylsalicylic acid was administered in only 31 cases overall, with no statistically significant difference between settings. This assessment advocates for the implementation of targeted actions, which may include updates to current legislation and policies. Conclusions: These findings highlight an urgent need to systematically evaluate existing workplace first-aid training and emergency protocols. Integrating modules on acetylsalicylic acid administration into training curricula, along with performance monitoring mechanisms, may significantly enhance early STEMI management and patient outcomes. Updating safety programs to align with evidence-based practices should follow a structured approach.

Purpose: Τo investigate via ultrasound whether the prophylactic use of acetylsalicylic acid 9 days after coronary angiography with transradial access reduces the incidence of radial occlusion. Material and Methods: Between March 2016 to September 2017 we studied 100 patients (64 male, 36 females and mean age of 60.5 years) who underwent coronary angiography with transradial (TRA) access. Patients after coronary angiography were divided into 2 equal groups with similar characteristics (mean age, mean BMI) were the Group A received for 9 days acetylsalicylic acid 100 mg while the Group B was untreated. All patients were tested with Doppler ultrasound 1 month after coronary angiography. Statistical analysis was performed with SPSS (Version 25). Results: Statistical analysis of ultrasound data showed that there is a statistically significant difference between patients receiving acetylsalicylic acid as a precautionary measure for radial artery occlusion after catheterization for coronary angiography and non-treated patients X2 (2, N=100) 24.04, p < 0.05). Conclusion: The results of the study suggest that use of acetylsalicylic acid following coronary artery angiography with TRA technique may reduce the risk of the radial artery occlusion and its complications. Doppler ultrasound is an easy and reliable method for assessing the flow of the radial artery.

The most important clinical aspect of Kawasaki disease is the cardiovascular problems. This article reports on the cardiovascular spectrum in acute Kawasaki disease, analysis of myocardial infarction and fatal cases, a follow-up study on the natural history of coronary artery lesions, long-term cardiovascular problems including premature atherosclerosis, problems in the adult cardiology and the treatment of acute Kawasaki disease. The etiology and pathogenesis of this disease are still unknown. Current hypotheses and leading studies on the etiology and the pathogenesis of Kawasaki disease are also reviewed.