Pros and Cons of Aspirin Prophylaxis for Prevention of Cardiovascular Events in Kidney Transplantation and Review of Evidence

Abstract

Kidney transplant recipients have traditional and nontraditional risk factors which can lead to coronary artery disease and sudden death with a functional graft loss. Aspirin has been used traditionally for prevention of cardiovascular and cerebrovascular accidents. It has beneficial effects in secondary prevention of cardiovascular events in general population. Its use for primary prophylaxis is still disputed. Bleeding and theoretical risk of nephrotoxicity are the major concerns about its use. The data on aspirin in kidney transplant population is sparse. This review will focus on various pros and cons of aspirin use for prevention of cardiovascular events in kidney transplant recipients and a way forward.

Alterations in Energy Metabolism, Mitochondrial Function and Redox Homeostasis in GK Diabetic Rat Tissues Treated with Aspirin

“…Non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, known mainly for their anti-inflammatory, antipyretic and analgesic effects, have shown beneficial effects in diabetes prevention/treatment [12]. Aspirin is a multifunctional drug, with different mechanisms, including inhibition of platelet function via the acetylation of cyclooxygenase-1 (COX-1) and inhibition of prostaglandin production via the acetylation of COX-2, expressed by cytokines and other inflammatory stimuli [13]. More recently, low dose aspirin has been suggested as an important pharmacological strategy to prevent the 'cytokine storm' commonly seen in COVID-19 patients [14].…”

The Living-Related Kidney Transplant Program in Brunei Darussalam: Lessons Learnt from a Nascent National Program in a Small, Muslim, and Asian Country

“…To maintain self-sufficiency and governance, we have an active research unit that had churned out several review articles on transplantation between 2017 and 2019. is was to enable the team to acquaint themselves with transplant literature and keep abreast with the latest transplant developments. Review articles have been published on aspirin usage in kidney transplants [27], hematological cytopenia in kidney transplants [28], use of fluoroquinolone in BK virus nephropathy [29], cigarette smoking in kidney transplants [30], and dual kidney transplantations [31]. Another recent local-driven study in 2017 showed that lack of donors (71%), lack of awareness of the program (21.2%), and unwillingness to take risks (26.5%) were the main barriers to the progress of the program [32].…”

Effect of Aspirin on Mitochondrial Dysfunction and Stress in the Pancreas and Heart of Goto-Kakizaki Diabetic Rats

“…Aspirin (acetylsalicylic acid, ASA), one of the most widely used NSAIDs, is a multifunctional drug, which affects different metabolic pathways in the body with various mechanisms [ 3 ]. The well-known mechanism of action of aspirin includes the inhibition of platelet function via the acetylation of COX-1, resulting in antithrombotic effects, and inhibition of prostaglandin production via the acetylation of COX-2, expressed by cytokines and other inflammatory stimuli [ 15 ]. It has been shown that low-dose aspirin (75–100 mg/day) was sufficient to inhibit COX-1, whereas intermediate doses (650 mg to 4 g/day) were required to inhibit COX-1 and COX-2 [ 16 ].…”