Prior aspirin users with acute non-ST-elevation coronary syndromes are at increased risk of cardiac events and benefit from enoxaparin

Santopinto, José; Gurfinkel, Enrique P.; Torres, Violeta; Marcos, Eduardo; Bozovich, Gerardo E.; Mautner, Branco; McCabe, Carolyn H.; Antman, Elliott M.

doi:10.1067/mhj.2001.113994

Cited by 44 publications

(32 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[2][3][4] In addition, subgroup analyses of randomized trials have shown that non-ST-elevation (NSTE) ACS patients previously on ASA therapy have worse short-term outcomes than those not previously on aspirin. 5,6 Surprisingly, opposite results have also been reported in a large registry. 7 In this registry, patients with coronary artery disease (CAD) had better outcomes if they were previously on ASA.…”

mentioning

confidence: 58%

“…Some randomized studies have reported prior use of OAA to be an independent predictor of adverse outcome both short term and long term. 5,6 In contrast, another study 7 failed to show a relation between prior use of OAA and clinical outcomes, probably because of differences in types of population, statistical methods, and study design. 3,15 In the present study and as previously reported, 2-7 prior users of OAA have apparently less severe clinical presentation than nonusers, although they carry a much higher risk profile than nonusers.…”

Section: Discussionmentioning

confidence: 95%

“…Indeed, if unidentified, recent withdrawers would have been classified as prior users; consequently, prior users would have had a significantly poorer outcome than nonusers in our study (30-day death or MI rate of 10.3% versus 14.1% for nonusers and prior users, respectively; Pϭ0.04), thereby resembling findings of randomized studies. 5,6 On the other hand, considering the specific GRACE definitions, recent withdrawers would have been classified as nonusers, which may explain why the nonusers had a worse outcome than prior users in this registry.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Antiplatelet Agents in Acute Coronary Syndromes

Sakhuja¹,

Yeh²,

Bhatt³

2010

Current Problems in Cardiology

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 58%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antiplatelet Agents in Acute Coronary Syndromes

Sakhuja¹,

Yeh²,

Bhatt³

2010

Current Problems in Cardiology

View full text Add to dashboard Cite

show abstract

“…2 A similar effect of enoxaparin was reported at 43 days in TIMI 11b. 3 Given these findings, enoxaparin is preferred over UFH in the current ACC/AHA unstable angina and non-STEMI guidelines. 6 In PRISM-PLUS the addition of the GP IIb/IIIa inhibitor tirofiban to UFH showed a 32% relative risk reduction over UFH alone in the prior aspirin users at 7 days.…”

Section: Differential Response To Therapy In Subjects With Prior Aspimentioning

confidence: 99%

“…As 84% of the subjects were prior aspirin users, the overall outcome of the study showed a favorable response to enoxaparin over UFH (OR 0.85; 0.72-1.00). 3 …”

Section: Implications For Clinical Trialsmentioning

confidence: 99%

The Role of Aspirin Resistance in the Treatment of Acute Coronary Syndromes

Lancaster

Jain

Zarich

2007

Clinical Cardiology

View full text Add to dashboard Cite

SummaryThe thrombosis in myocardial infarction (TIMI) Risk Score recognizes prior aspirin use as an independent risk factor for adverse outcomes in subjects presenting with an acute coronary syndrome. The etiology of this increased risk awaits clarification, but prior aspirin use may be associated with altered thrombus composition which is more resistant to current treatment modalities as compared with thrombus formation in subjects without prior aspirin use. Post hoc analysis of acute coronary syndrome trials has shown that prior aspirin users treated with unfractionated heparin are at particularly high risk. The addition of glycoprotein IIb/IIIa receptor inhibitor to unfractionated heparin or substitution of low-molecularweight heparin significantly improves outcomes in prior aspirin users. The prognostic significance of prior aspirin use in acute coronary syndromes has important implications not only in clinical practice, but also in the design and interpretation of clinical trials.

show abstract

Impact of Chronic Antithrombotic Therapy on Hospital Course of Patients with Acute Myocardial Infarction

Bauer

Gitt

Zahn

et al. 2009

Clinical Cardiology

View full text Add to dashboard Cite

Background Little is known about the influence of chronic antithrombotic therapy on treatment and clinical outcome in patients with acute ST‐elevation myocardial infarction (STEMI). Hypothesis The purpose of this study was to investigate the hospital course of STEMI patients on antithrombotics. Methods We analyzed data of consecutive patients with STEMI, who were prospectively enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002. Overall, 8224 patients were stratified into 3 groups: group 1 had no prior chronic antithrombotic medication (n = 6004), group 2 was on chronic acetylsalicylic acid (ASA) therapy (n = 2022), and group 3 was on chronic oral anticoagulation therapy (n = 198). Results Patients on antithrombotic medication were older and had a higher baseline risk profile. The rate of patients receiving early reperfusion (group 1: 74.6%, group 2: 61.2%, group 3: 52.0%) and guideline‐adherent adjustment therapy was lower among patients on antithrombotics. Age and left bundle branch block were strong negative predictors for early reperfusion therapy in patients with prior antithrombotic treatment. Infarct size measured by peak creatine kinase level was lower in patients on antithrombotics. Hospital mortality (group 1: 8.0%, group 2: 12.8%, group 3: 16.2%) and major bleeding complications (group 1: 1.6%, group 2 2.0%, group 3 4.1%) were highest in patients on oral anticoagulants. However, after adjustment for confounding factors, prior ASA (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.80–1.21) and oral anticoagulant treatment (OR: 1.06, 95% CI: 0.66–1.71) were not independent predictors for in‐hospital death. Conclusions Despite a higher risk profile, patients with STEMI on a chronic antithrombotic therapy were less likely to receive early reperfusion therapy. However, after adjustment, prior ASA or oral anticoagulant therapy was not associated with higher in‐hospital mortality. Copyright © 2009 Wiley Periodicals, Inc.

show abstract

Prior aspirin users with acute non-ST-elevation coronary syndromes are at increased risk of cardiac events and benefit from enoxaparin

Cited by 44 publications

References 22 publications

Antiplatelet Agents in Acute Coronary Syndromes

Antiplatelet Agents in Acute Coronary Syndromes

The Role of Aspirin Resistance in the Treatment of Acute Coronary Syndromes

Impact of Chronic Antithrombotic Therapy on Hospital Course of Patients with Acute Myocardial Infarction

Contact Info

Product

Resources

About