Aspirin Resistance in Vascular Disease: A Review Highlighting the Critical Need for Improved Point-of-Care Testing and Personalized Therapy

Khan, Hamzah; Kanny, Omar; Syed, Muzammil H.; Qadura, Mohammad

doi:10.3390/ijms231911317

Cited by 23 publications

(13 citation statements)

References 113 publications

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“…Blood samples from patients were analysed two weeks after commencement of treatment using thromboelastography (TEG®) 16,28 and the PFA200 platelet function analyser 29 . These analyses were done to ensure that a hypocoagulable state putting the patient at risk of bleeding had not been induced 30 , and to rule out clopidogrel and/or aspirin resistance 31,32,33,34…”

Section: Anticoagulant Treatment Regimenmentioning

confidence: 99%

Treatment of Long COVID symptoms with triple anticoagulant therapy

Laubshder

Khan

Venter

et al. 2023

Preprint

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Background: Fibrin(ogen) amyloid microclots and platelet hyperactivation are key pathological findings in patients with acute COVID-19 infection and also in those with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). These pathologies may represent a suitable target for pharmacological treatment of Long COVID. Methods: Here we report on the symptoms displayed by a cohort of 91 South African Long COVID patients at baseline and after a clinician-initiated anticoagulant regime was completed. For laboratory analysis, patients provided a blood sample before and after treatment. Fibrinaloid microclot presence was studied by adding thioflavin T to platelet poor plasma (PPP), whilst platelet hyperactivation was studied using two platelet markers- PAC1 and CD62P (P-selectin). The anticoagulant regime included dual antiplatelet therapy (DAPT- Clopidogrel 75mg + Aspirin 75mg) once a day, and a direct oral anticoagulant (DOAC- Apixaban) 5mg twice a day. A proton pump inhibitor (PPI) pantoprazole 40 mg/day was also prescribed for gastric protection. Each of the treated cases reported their main Long COVID symptoms, and whether their symptoms resolved following treatment or not. Results: In our cohort a most participants did not report any comorbidities before acute COVID-19 infection. Hypertension and dyslipidaemia were the commonest underlying illnesses, whilst the most commonly reported Long COVID symptoms included fatigue, cognitive dysfunction, shortness of breath, and joint and muscle pains. Following completion of treatment, each of the different symptoms resolved in the majority of patients. This was also reflected in the laboratory analysis, where a decrease in the severity of fibrin amyloid microclotting and the degree of platelet pathology was noted. No serious adverse bleeding events were reported. Conclusions: Fibrin amyloid microclots, platelet hyperactivation/ aggregation, and widespread endothelialitis inhibit the transport of oxygen at a capillary/cellular level. This provides a ready explanation for the symptoms of Long COVID. By normalizing the failed clotting physiology and reversal of the endothelialitis, triple anticoagulant therapy represents a promising treatment option that appears to be highly efficacious, and warrants controlled clinical studies. We caution that such a regime must only be followed under expert medical supervision in view of the risk of bleeding.

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Section: Anticoagulant Treatment Regimenmentioning

confidence: 99%

Treatment of Long COVID symptoms with triple anticoagulant therapy

Laubshder

Khan

Venter

et al. 2023

Preprint

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“…For example, based on the existing literature, the incidence of aspirin resistance in the population ranges from 0.4% to 83.3%. 4 The exact mechanism of antiplatelet drug resistance has not been fully elucidated. Studies have shown that gene polymorphism is one of the factors affecting antiplatelet drug resistance and this will be discussed further in this narrative review.…”

Section: Introductionmentioning

confidence: 99%

Epoxidase inhibitor-aspirin resistance and the relationship with genetic polymorphisms: a review

Hou

2024

J Int Med Res

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Strokes are the leading cause of death in most regions of the world. Epoxidase inhibitors include the drug aspirin (acetylsalicylic acid). Aspirin is widely used as first-line treatment for the prevention of cardiovascular and cerebrovascular diseases in at-risk patients. However, patients using conventional doses of aspirin can still develop ischaemic cardiovascular and cerebrovascular diseases, a phenomenon known as aspirin resistance. The occurrence of aspirin resistance hinders the prevention and treatment of ischaemic cardiovascular and cerebrovascular diseases. There are many factors affecting aspirin resistance, such as sex, drug dose, metabolic disease, genetic polymorphisms, drug interactions and pharmacokinetics. Genetic polymorphism refers to the simultaneous and frequent presence of two or more discontinuous variants or genotypes or alleles in a population of organisms. Platelets contain a large number of highly polymorphic transmembrane glycoprotein receptors encoded by two or more isomeric alleles. Changes in gene polymorphisms in various pathways during platelet aggregation can lead to aspirin resistance. This narrative review describes the gene polymorphisms that have been demonstrated to be significantly associated with aspirin resistance. Research on the mechanisms of aspirin resistance and increased knowledge should provide accurate drug guidance in individuals that require first-line antiplatelet therapy.

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“…Although other anti-platelet drugs, such as clopidogrel, have shown almost the same activity, acetylsalicylic acid is still one of the treatment therapies for the population of patients with this disease. The relatively low cost and ease of acquisition in healthcare are the primary reasons for the predominant use of acetylsalicylic acid over other antiplatelet drugs [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Safety Effects of Antiplatelets on the Kidneys in Patients with Vascular Disease

2024

FEM

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Aims: Most vascular disorders fall under the category of inflammatory diseases because they gradually harm blood vessels, disrupting the normal flow of blood to and from vital organs. The purpose of this research was to determine the potential dangers to kidney health associated with acetylsalicylic acid and clopidogrel treatment in patients with vascular diseases. Methodology: A cross-sectional research design was employed in the study, as well as retrospective data collection methods on medical records, and purposive sampling-based data sampling methodologies. Results: The study's findings indicated that there was no significant correlation between the use of antiplatelets and the risk of developing kidney disorders. It is rather, a patient's lifestyle, use of medications that increase the risk of renal GFR, and co-occurring diseases that may impair blood flow in the renal afferen can all increase their risk of developing a renal disorder with p-value <0.05. Nevertheless, the prolonged use of medication also plays a significant role in kidney function. The study's results indicate that renal problems are not attributed to the usage of antiplatelet drugs such as clopidogrel and acetylsalicylic acid. Scientific Novelty: Several using antiplatelet for indicated cardiovascular disease such us, atherosclerosis, plaque formation, endothelial dysfunction, and blockage or damage to the vascular endotelial matrix are all symptoms of vascular disease, a progressive inflammatory illness, it's frequently associated with the risk of kidney disorders. The use of antiplatelet will enlarge the afferent blood vessels. Conclusion: Instead, factors such as a patient's lifestyle, the severity of their condition, and their medical history could have a more significant impact on the likelihood of developing kidney dysfunction.

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Aspirin Resistance in Vascular Disease: A Review Highlighting the Critical Need for Improved Point-of-Care Testing and Personalized Therapy

Cited by 23 publications

References 113 publications

Treatment of Long COVID symptoms with triple anticoagulant therapy

Treatment of Long COVID symptoms with triple anticoagulant therapy

Epoxidase inhibitor-aspirin resistance and the relationship with genetic polymorphisms: a review

Comparison of the Safety Effects of Antiplatelets on the Kidneys in Patients with Vascular Disease

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