Renal effects of aspirin are clearly dose‐dependent and are of clinical importance from a dose of 160 mg

Juhlin, Tord; Jönsson, Bo; Höglund, Peter

doi:10.1016/j.ejheart.2008.06.014

Cited by 26 publications

(19 citation statements)

References 37 publications

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“…Although nephrotoxicity from non-steroidal anti-inflammatory agents is well appreciated (through the inhibition of intrarenal prostaglandin), aspirin doses of 100 mg/day, as used in POISE-2, are unlikely to be nephrotoxic. 32 However, bleeding with aspirin is an important concern which can cause hypotension and AKI. 7 33 Similarly, blood transfusions may directly predispose to AKI, possibly through some haemolysis.…”

Section: Postoperative Cardiac Eventsmentioning

confidence: 99%

Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

et al. 2014

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IntroductionPerioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce the risk of postoperative acute kidney injury (AKI).Methods and analysisAfter receipt of grant funding, serial postoperative serum creatinine measurements began to be recorded in consecutive patients enrolled at substudy participating centres. With respect to the study schedule, the last of over 6500 substudy patients from 82 centres in 21 countries were randomised in December 2013. The authors will use logistic regression to estimate the adjusted OR of AKI following surgery (compared with the preoperative serum creatinine value, a postoperative increase ≥26.5 μmol/L in the 2 days following surgery or an increase of ≥50% in the 7 days following surgery) comparing each intervention to placebo, and will report the adjusted relative risk reduction. Alternate definitions of AKI will also be considered, as will the outcome of AKI in subgroups defined by the presence of preoperative chronic kidney disease and preoperative chronic aspirin use. At the time of randomisation, a subpopulation agreed to a single measurement of serum creatinine between 3 and 12 months after surgery, and the authors will examine intervention effects on this outcome.Ethics and disseminationThe authors were competitively awarded a grant from the Canadian Institutes of Health Research for this POISE-2 AKI substudy. Ethics approval was obtained for additional kidney data collection in consecutive patients enrolled at participating centres, which first began for patients enrolled after January 2011. In patients who provided consent, the remaining longer term serum creatinine data will be collected throughout 2014. The results of this study will be reported no later than 2015.Clinical Trial Registration NumberNCT01082874.

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Section: Postoperative Cardiac Eventsmentioning

confidence: 99%

Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

et al. 2014

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“…Moreover, chronic large dose of aspirin use may reduce renal blood flow and glomerular filtration and impair renal function due to the inhibition of COX-2-dependent PGI2, which support renal perfusion, diminish vascular resistance, and facilitate natriuresis [54]. This side effect often occurs at high aspirin doses and most frequently in elderly patients and those with established renal disease.…”

Section: Adverse Effectsmentioning

confidence: 99%

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Dai

2012

Thrombosis

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Cardiovascular disease (CVD), principally heart disease and stroke, is the leading cause of death for both males and females in developed countries. Aspirin is the most widely used and tested antiplatelet drug in CVD, and it is proven to be the cornerstone of antiplatelet therapy in treatment and prevention of CVD in clinical trials in various populations. In acute coronary syndrome, thrombotic stroke, and Kawasaki's disease, acute use of aspirin can decrease mortality and recurrence of cardiovascular events. As secondary prevention, aspirin is believed to be effective in acute coronary syndrome, stable angina, revascularization, stroke, TIA, and atrial fibrillation. Aspirin may also be used for patients with a high risk of future CVD for primary prevention, but the balance between benefits and the possibility of side effects must be considered.

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“…Juhlin et al 9 have demonstrated dose-dependent adverse renal effects of aspirin at doses >80 mg, which may be of particular concern in an HF population. A registry study of the dose-related effects of aspirin in patients with HF showed that patients prescribed an angiotensin-converting enzyme (ACE) inhibitor and high-dose aspirin (≥325 mg/d) had a significantly raised mortality risk compared with patients with ACE inhibitor and no aspirin use, whereas there was no increased risk in patients with ACE inhibitor and low-dose aspirin (≤160 mg/d).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the adverse renal and gastrointestinal effects of aspirin are more evident at doses >80 mg, 9,10 and the Antithrombotic Trialists group recommends aspirin at doses of 75 to 150 mg daily for cardiovascular protection because this dose is clinically effective and minimizes risk of adverse events. 11 However, the WASH, WATCH, and WARCEF studies used daily doses of 300, 162, and 325 mg, respectively.…”

Section: Editorial See P 237 Clinical Perspective On P 250mentioning

confidence: 99%

Aspirin Use in Heart Failure

Bermingham

Shanahan

O’Connell

et al. 2014

Circ: Heart Failure

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Background-Aspirin use in heart failure (HF) is controversial. The drug has proven benefit in comorbidities associated with HF; however, retrospective analysis of angiotensin-converting enzyme inhibitor trials and prospective comparisons with warfarin have shown increased risk of morbidity with aspirin use. This study aims to evaluate the association of lowdose aspirin with mortality and morbidity risk in a large community-based cohort. Methods and Results-This was a retrospective cohort study of patients attending an HF disease management program.Aspirin use at baseline and its association with mortality and HF hospitalization in the population was examined. Of 1476 patients (mean age, 70.4±12.4 years; 63% men), 892 (60.4%) were prescribed aspirin. Low-dose aspirin (75 mg/d) was prescribed to 828 (92.8%) patients. Median follow-up time was 2.6 (0.8-4.5) years. During the follow-up period, 464 (31.4%) patients died. In adjusted analysis, low-dose aspirin use was associated with reduced mortality risk compared with nonaspirin use (hazard ratio=0.58; 95% confidence interval, 0.46-0.74), and this was confirmed by a propensity-matched subgroup analysis. Low-dose aspirin use was associated with reduced risk of HF hospitalization compared with nonaspirin use in the total population (adjusted hazard ratio=0.70; 95% confidence interval, 0.54-0.90). In adjusted analysis, there was no difference in mortality or HF hospitalization between high-dose aspirin users (>75 mg/d) and nonaspirin users. Conclusions-In this study, low-dose aspirin therapy was associated with a significant reduction in mortality and morbidity risk during long-term follow-up. These results suggest that low-dose aspirin may have a continuing role in secondary prevention in HF and underline the need for more trials of low-dose aspirin use in HF. The risk-benefit ratio of aspirin in HF may be dose related. It has been shown that the adverse renal and gastrointestinal effects of aspirin are more evident at doses >80 mg, 9,10 and the Antithrombotic Trialists group recommends aspirin at doses of 75 to 150 mg daily for cardiovascular protection because this dose is clinically effective and minimizes risk of adverse events.11 However, the WASH, WATCH, and WARCEF studies used daily doses of 300, 162, and 325 mg, respectively. [1][2][3] Indeed, in one of the retrospective registry analyses of aspirin in HF to date, a large proportion of patients received aspirin at higher antiplatelet doses (325 mg/d), 7 and in other analyses, the dose used was not available, possibly explaining the adverse events and excess of HF hospitalizations observed.There have been few large studies of aspirin use in real-world HF populations with lengthy follow-up times. This study aims to provide information on the association of low-dose aspirin with mortality and HF hospitalization risk in a large community-based cohort participating in a disease management program (DMP). MethodsThis is a retrospective cohort study of patients with HF attending a DMP in St Vincent's University Hospit...

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Renal effects of aspirin are clearly dose‐dependent and are of clinical importance from a dose of 160 mg

Cited by 26 publications

References 37 publications

Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

Aspirin Use in Heart Failure

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