Browsing by Subject "aspirin"

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  • NAVIGATE ESUS Steering Comm (2018)
    Background: The New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs. ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is a randomized phase-III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. Aims: We aimed to describe the baseline characteristics of this large ESUS cohort to explore relationships among key subgroups. Methods: We enrolled 7213 patients at 459 sites in 31 countries. Prespecified subgroups for primary safety and efficacy analyses included age, sex, race, global region, stroke or transient ischemic attack prior to qualifying event, time to randomization, hypertension, and diabetes mellitus. Results: Mean age was 66.9 +/- 9.8 years; 24% were under 60 years. Older patients had more hypertension, coronary disease, and cancer. Strokes in older subjects were more frequently cortical and accompanied by radiographic evidence of prior infarction. Women comprised 38% of participants and were older than men. Patients from East Asia were oldest whereas those from Latin America were youngest. Patients in the Americas more frequently were on aspirin prior to the qualifying stroke. Acute cortical infarction was more common in the United States, Canada, and Western Europe, whereas prior radiographic infarctions were most common in East Asia. Approximately forty-five percent of subjects were enrolled within 30 days of the qualifying stroke, with earliest enrollments in Asia and Eastern Europe. Conclusions: NAVIGATE-ESUS is the largest randomized trial comparing antithrombotic strategies for secondary stroke prevention in patients with ESUS. The study population encompasses a broad array of patients across multiple continents and these subgroups provide ample opportunities for future research.
  • Turpeinen, Heikki; Laulajainen-Hongisto, Anu; Lyly, Annina; Numminen, Jura; Penttilä, Elina; Sahlman, Johanna; Toppila-Salmi, Sanna; Kauppi, Paula (2021)
    Introduction: NSAID-exacerbated respiratory disease (N-ERD) is mainly treated with topical and oral corticosteroids, as well as acetylsalicylic acid (ASA) treatment after desensitization (ATAD). During desensitization and ATAD, it is common to experience an exacerbation of respiratory symptoms and other side effects, which may lead to cessation of treatment. Objectives: The aim of this retrospective follow-up study was to evaluate the effect of ATAD on lung functions and respiratory symptoms, and to clarify the occurrence of adverse events. Methods: We analysed the patient data of 67 patients treated with ASA desensitization between 2006 and 2016 in three hospitals, concerning adverse events, respiratory symptoms, lung function tests, and reasons for discontinuation. Results: 26 patients discontinued AD or ATAD. The most common reasons for discontinuation were lack of response (9%) and side effects (18%). ATAD did not affect lung function values in the follow-up of up to 5 years. Upper respiratory symptoms improved in 31 (52%) and lower respiratory symptoms (LRS) in 7 (10%) cases. Side effects occurred in 42 (63%) cases, the most common being dyspepsia and lower respiratory symptoms. Conclusion: Our study suggests that ATAD has little effect on lower airway functions. Side effects were common, and discontinuation rates high.
  • Kalapotharakos, Grigorios; Murtoniemi, Katja; Åkerström, Bo; Hämäläinen, Esa; Kajantie, Eero; Räikkönen, Katri; Villa, Pia; Laivuori, Hannele; Hansson, Stefan R. (2019)
    Women with established preeclampsia (PE) have increased plasma concentration of free fetal hemoglobin. We measured two hemoglobin scavenger system proteins, hemopexin (Hpx) and alpha-1 -microglobulin (A1M) in maternal plasma using enzyme-linked immunosorbent assay during the late second trimester of pregnancy in women with high and low risk of developing PE. In total 142 women were included in nested case-control study: 42 women diagnosed with PE and 100 controls (49 randomly selected high-risk and 51 low-risk controls). The concentration of plasma A1M in high-risk controls was higher compared to low-risk controls. Women with severe PE had higher plasma A1M levels compared to women with non-severe PE. In conclusion, the concentration of plasma A1M is increased in the late second trimester in high-risk controls, suggesting activation of endogenous protective system against oxidative stress.
  • NAVIGATE ESUS Investigators; Martinez-Majander, Nicolas; Ntaios, George; Liu, Yan Yun; Ylikotila, Pauli; Joensuu, Heikki; Saarinen, Jukka; Tiainen, Marjaana; Tatlisumak, Turgut (2020)
    Abstract Background Cancer is a frequent finding in ischemic stroke patients. We investigated the frequency of cancer among participants in NAVIGATE ESUS randomized trial and the distribution of outcome events during treatment with aspirin and rivaroxaban. Methods Trial participation required a recent embolic stroke of undetermined source (ESUS). Patients? history of cancer was recorded at time of study entry. During a mean follow-up of 11 months, the effects of aspirin and rivaroxaban treatment on recurrent ischemic stroke, major bleeding, and all-cause mortality were compared between patients with cancer and without cancer. Results Among 7213 randomized patients, 543 (7.5%) had cancer. Of all patients, 3609 were randomized to rivaroxaban (254[7.0%] with cancer) and 3604 patients to aspirin (289[8.0%] with cancer). The annual rate of recurrent ischemic stroke was 4.5% in non-cancer patients in rivaroxaban arm and 4.6% in the aspirin arm (hazard ratio, HR 0.98 [95% CI 0.78-1.24]). In cancer patients, the rate of recurrent ischemic stroke was 7.7% in the rivaroxaban arm and 5.4% in the aspirin arm (HR 1.43 [95% CI 0.71-2.87]). Among cancer patients, the annual rate of major bleeds was nonsignificantly higher for rivaroxaban than aspirin (2.9% versus 1.1%; HR 2.57 [95% CI 0.67-9.96], P for interaction 0.95). All-cause mortality was similar in both groups. Conclusions Our exploratory analyses show that patients with ESUS and a history of cancer had similar rates of recurrent ischemic strokes and all-cause mortality during aspirin and rivaroxaban treatments and that aspirin appeared safer than rivaroxaban in cancer patients regarding major bleeds.
  • Webb, P. M.; Na, R.; Weiderpass, E.; Adami, H. O.; Anderson, K. E.; Bertrand, K. A.; Botteri, E.; Brasky, T. M.; Brinton, L. A.; Chen, C.; Doherty, J. A.; Lu, L.; McCann, S. E.; Moysich, K. B.; Olson, S.; Petruzella, S.; Palmer, J. R.; Prizment, A. E.; Schairer, C.; Setiawan, V. W.; Spurdle, A. B.; Trabert, B.; Wentzensen, N.; Wilkens, L.; Yang, H. P.; Yu, H.; Risch, H. A.; Jordan, S. J. (2019)
    Background: Regular use of aspirin has been associated with a reduced risk of cancer at several sites but the data for endometrial cancer are conflicting. Evidence regarding use of other analgesics is limited. Patients and methods: We pooled individual-level data from seven cohort and five case-control studies participating in the Epidemiology of Endometrial Cancer Consortium including 7120 women with endometrial cancer and 16 069 controls. For overall analyses, study-specific odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression and combined using random-effects meta-analysis; for stratified analyses, we used mixed-effects logistic regression with study as a random effect. Results: At least weekly use of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an approximately 15% reduced risk of endometrial cancer among both overweight and obese women (OR 1/4 0.86 [95% CI 0.760.98] and 0.86 [95% CI 0.76-0.97], respectively, for aspirin; 0.87 [95% CI 0.76-1.00] and 0.84 [0.74-0.96], respectively, for nonaspirin NSAIDs). There was no association among women of normal weight (body mass index<25 kg/ m2, Pheterogeneity 0.04 for aspirin, Pheterogeneity 1/4 0.003 for NSAIDs). Among overweight and obese women, the inverse association with aspirin was stronger for use 2-6 times/ week (OR 1/4 0.81, 95% CI 0.68-0.96) than for daily use (0.91, 0.80-1.03), possibly because a high proportion of daily users use low-dose formulations. There was no clear association with use of acetaminophen. Conclusion: Our pooled analysis provides further evidence that use of standard-dose aspirin or other NSAIDs may reduce risk of endometrial cancer among overweight and obese women.