The use of aspirin as a therapy for coronary artery disease is common, and this analysis will form the major part of this discussion. Xian et al. (2015) researched the optimal maintenance dose after percutaneous coronary intervention with stenting. In the study of 10213 patients in 228 US hospitals, the number of major adverse cardiovascular events and bleeding were compared between those on 325mg of aspirin and those on 81mg. It was found that 63% of patients were prescribed the high dose regimen. There was no significant difference in the risk of adverse cardiovascular events between the two groups, although those on the higher dosage of aspirin were more likely to experience any Bleeding Academic Research Consortium-defined bleeding events. This suggests that a lower dose of aspirin may be safer in the first six months after myocardial infarction.
The use and effectiveness of aspirin depends on the type of coronary artery disease. Bavry et al. (2015) investigated the impact of aspirin in stable versions of coronary artery disease, hypothesizing that the benefit would be different in individuals who had coronary artery disease but had not previously had an ischemic event. In the observational study, 22,576 patients were investigated, with 56.7% of participants using aspirin. In the non-ischemic (no angina, myocardial infarction, stroke or transient ischemic attack) group did not have a reduction in risk, but in the ischemic group there was an association. This suggests that aspirin may only be useful for those who had experienced an ischemic event.
Huang et al. (2015) also considered the perioperative use of aspirin and the effects that it has on those undergoing various types of cardiac operation. Preoperative aspirin therapy was associated with a 49% chance of bleeding in 868 matched pairs of patients having valve surgery. In the group of 725 patients who were having a coronary artery bypass grafting, there was no increased risk of bleeding during the surgery. In both groups, there was no increased risk of cardiac, cerebral or renal complications, suggesting that aspirin remains a safe therapy in cardiovascular patients.
Brouwer et al. (2002) conducted a comparative study on the impact of prolonged anticoagulation therapies as an adjunct to aspirin. In a comparison of 308 patients who had recently experienced a patent infarct-related artery. They were randomly assigned to one of two groups, standard heparinization and continuation of aspirin, or this therapy combined with moderate-intensity coumarin for three months. It was found that reocclusion was less common in those on the combined aspirin and coumarin therapies (28%) than in those receiving only aspirin therapies (15%). This suggests that coumarin in combination with aspirin may be a more effective therapy for coronary artery disease.
An assessment of whether thrombolytic therapy helps or harms the patient in various cardiovascular conditions is also useful. Jovic et al. (2015) present a case study on a woman who had an acute myocardial infarction due to spontaneous coronary artery dissection. The patient was treated with thrombolytic therapy and had a coronary angiography. After two years, it was found that her coronary artery was normal, which mirrors findings from a review of 19 cases between 1996 and 2002 also presented by Jovic et al. (2015). Although the number of case studies is small, it does suggest that thrombolytic therapy may be a useful alternative to other forms of therapies in these patients.
Similarly, Kessel & Patel (2004) investigated the current trends in thrombolysis, which they suggest are relevant to both diagnostic and interventional clinical staff, particularly in the context of radiology. It was found that thrombolysis is becoming more relevant to acute stroke. This is a literature review focused on presenting and dissecting current findings, which include a discussion of various thrombolytic agents, including streptokinase, urokinase, recombinanr tissue plasminogen activator and reteplase.
Wallace & Smith (2012) presented a case report of a 70 year-old functional male who had experienced a spontaneous coronary thrombosis following thrombolytic therapy after an acute cerebrovascular accident. This suggests that, contrary to some previously presented findings, thrombolytic therapies in some patients may lead to an underlying systemic pro-thrombotic event, which can predispose some individuals to thrombosis. It is useful to consider cases such as these to enrich our understanding of thrombolytic agents.
Jazi, Nazary & Behjati (2012) investigated the responses of thrombolytic agents in opium abusers and compared this response to non-abusers. This is interesting because opium users have different levels of circulating coagulation factors which changes their response to a variety of medications. In the observational study, 36 opium abusers and 47 non-abusers with acute myocardial infarction were evaluated in their response to thrombolytic agents. The electrocardiographic changes after the thrombolysis treatments were lower in opium abusers than in non-users, which suggests that thrombolytic therapies may be more effective in this group.
In conclusion, aspirin remains a valid therapy in a number of cases, and thrombolysis can be used concurrently – safely and with potentially better effects. This, however, depends on the status of the patient (opium abusers will benefit less) and the type of cardiac event they are being treated for.
- Bavry, A. A., Gong, Y., Handberg, E. M., Cooper-DeHoff, R. M., & Pepine, C. J. (2015). Impact of Aspirin According to Type of Stable Coronary Artery Disease: Insights from a Large International Cohort. The American Journal of Medicine, 128(2), 137–143.
- Brouwer, M. A., van den Bergh, P. J., Aengevaeren, W. R., Veen, G., Luijten, H. E., Hertzberger, D. P., … Verheugt, F. W. (2002). Aspirin Plus Coumarin Versus Aspirin Alone in the Prevention of Reocclusion After Fibrinolysis for Acute Myocardial Infarction Results of the Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis (APRICOT)-2 Trial. Circulation, 106(6), 659–665.
- Huang, J., Donneyong, M., Trivedi, J., Barnard, A., Chaney, J., Dotson, A., … Slaughter, M. S. (2015). Preoperative Aspirin Use and Its Effect on Adverse Events in Patients Undergoing Cardiac Operations. The Annals of Thoracic Surgery. Retrieved from http://www.sciencedirect.com/science/article/pii/S0003497515002404
- Jazi, S. M. H., Nazary, I. A., & Behjati, M. (2012). Response to thrombolytic agents in acute myocardial infarction in opium abusers versus non-abusers. Journal of Research in Pharmacy Practice, 1(1), 34.
- Jović, Z., Obradović, S., DJenić, N., Mladenović, Z., DJurić, P., Spasić, M., & Tavčiovski, D. (2015). Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI) caused by the spontaneous coronary dissection? Vojnosanitetski Pregled, 72(6), 536–540.
- Kessel, D. O., & Patel, J. V. (2005). Current trends in thrombolysis: implications for diagnostic and interventional radiology. Clinical Radiology, 60(4), 413–424.
- Wallace, E. L., & Smyth, S. S. (2012). Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study. Journal of Thrombosis and Thrombolysis, 34(4), 548–551.
- Xian, Y., Wang, T. Y., McCoy, L. A., Effron, M. B., Henry, T. D., Bach, R. G., … Peterson, E. D. (2015). The Association of Discharge Aspirin Dose With Outcomes After Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Study. Circulation, CIRCULATIONAHA–114.