Summary
Although other mechanisms may be contributory, the antithrombotic properties of aspirin derive predominantly from its platelet-inhibitory effects. These are mediated via irreversible acetylation of platelet cyclo-oxygenase with subsequent blockade of platelet thromboxane synthesis. Long term administration of doses of aspirin as low as 20mg daily depresses platelet thromboxane formation by more than 90%; however, higher doses appear to be necessary to prevent thromboxane-dependent platelet activation in vivo. While there is evidence of biochemical selectivity with low doses of aspirin, significant reduction of the platelet-inhibitory eicosenoid, prostacyclin, occurs even at dosages ranging from 20 to 40mg daily.
The ability of aspirin to prevent the occurrence or recurrence ofvaso-occlusion has been extensively investigated. In the secondary prevention of myocardial infarction 7 placebocontrolled trials involving more than 15,000 patients have been completed. The dose of aspirin varied from 300 to 1500mg daily. Although none of the individual trials produced statistically significant reductions in total or coronary mortality, taken together the results are highly suggestive of a beneficial effect of aspirin. Similarly, 2 recent studies in patients with unstable angina demonstrated a protective effect of aspirin against acute myocardial infarction and death While each study employed widely different doses of aspirin (324mg and 1250mg daily) similar reductions in mortality were reported. The effects of aspirin on the prevention of coronary artery bypass graft occlusion have been evaluated in 9 trials. Aspirin in doses of 100 to 975mg daily was shown to be of benefit in preventing early (< 6 months) graft occlusion, particularly when therapy was started within 24 hours of operation. In patients with prosthetic vascular grafts of the lower limbs, aspirin has been shown to reduce platelet deposition, however further controlled trials will be required to establish the patient population most likely to benefit and, as in all these studies, the optimum dose of aspirin to employ.
In patients with prosthetic heart valves it is clear that aspirin alone is insufficient to prevent thromboembolic complications and when administered as an adjunct to anticoagulant therapy it is associated with a high incidence of bleeding. In contrast, there is convincing evidence from several studies for the efficacy of aspirin in doses of 990 to 1300mg daily in the prevention of stroke and death in patients with transient ischaemic attacks.
Overall, the results of these clinical studies suggest that the maximum benefit of aspirin is likely to be achieved by its administration early in the process of thrombosis when platelet-dependent mechanisms appear to be most important. Future applications for the use of aspirin include the evaluation of biochemically selective regimens of aspirin in modulating platelet activation during acute vascular occlusion and investigation of its potential role in the primary prevention of cardiovascular disease.
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References
Aharony D, Smith JB, Silver MJ. Regulation of arachidonate-induced platelet aggregation by the lipoxygenase product, 12-hydroperoxy eicosatetraenoic acid. Biochimica et Biophysica Acta 718: 193–200, 1982
Altman R, Boullon F, Rouvier J, Raca R, de la Fuente L, et al. Aspirin and prophylaxis of thromboembolic complications in patients with substitute heart valves. Journal of Thoracic and Cardiovascular Surgery 72: 127–129, 1976
American-Canadian Co-operative Study Group. Persantine aspirin trial in cerebral ischemia: part I; endpoint resume. Stroke 16: 406–415, 1985
Ashton JH, Taylor AL, Ogletree ML, et al. Serotonin and throm-boxane A2/PGH2 mechanisms are both important in mediating cyclical flow variations in severely stenosed canine coronary arteries. Abstract. Clinical Research 34: 707A, 1986
Aspirin Myocardial Infarction Study Research Group. A randomized controlled trial of aspirin in persons recovering from myocardial infarction. Journal of the American Medical Association 243: 661–669, 1980
Baenziger NL, Dillender MJ, Majerus PW. Cultured human skin fibroblasts and arterial cells produce a labile platelet inhibitory prostaglandin. Biochemical and Biophysical Research Communications 787: 294–301, 1977
Born GVR. Adenosine diphosphate as a mediator of platelet aggregation in vivo: an editorial view. Circulation 72: 741–746, 1985
Boston Collaborative Drug Surveillance Group. Regular aspirin intake and acute myocardial infarction. British Medical Journal 1: 440–443, 1974
Boumameaux H, Gresele P, Hanss M, DeCock F, Vermylen J, et al. Aspirin, indomethacin and dazoxiben do not affect the fibrinolytic activation induced by venous occlusion. Thrombosis Research 40: 161–170, 1985
Bousser MG, Eschwege E, Haguenau M, et al. ‘AICLA’controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke 14: 5–14,1983
Bowen-Pope DF, Ross R, Seifert RA. Locally acting growth factors for vascular smooth muscle cells: endogenous synthesis and release from platelets. Circulation 72: 735–740, 1985
Breddin K, Loew D, Lechner K, et al. Secondary prevention of myocardial infarction: comparison of acetylsalicylic acid, phenprocoumon and placebo. Thrombosis and Haemostasis 40: 225–236, 1979
Brittain RT, Bontal L, Carter MC, et al. AH23848: a thromboxane receptor-blocking drug that can classify the pathophysiologic role of thromboxane A2. Circulation 72: 1208–1218,1985
Brooks N, Wright J, Sturridge M. ct-al. Randomized placebo controlled trial of aspirin and dipyridamole in the prevention of coronary vein graft occlusion. British Heart Journal 53: 201–207, 1985
Brott WH, Zaytchuk R, Bowen TE, Davies J, Green DC. Dipyridamole-aspirin as thromboembolic prophylaxis in patients with aortic valve prosthesis. Journal of Thoracic and Cardiovascular Surgery 81: 632–635, 1981
Brown BG, Cukingnan RA, DeRouent G, et al. Improved graft patency in patients treated with platelet-inhibiting therapy after coronary bypass surgery. Circulation 72: 138–146, 1985
Buchanan MR, Richke JA, Hirsh J. Aspirin inhibits platelet function independent of the acetylation of cyclo-oxygenase. Thrombosis Research 25: 363–373, 1982
Burch JW, Baenziger NL, Stanford N, Majerus PW. Sensitivity of fatty acid cyclo-oxygenase from human aorta to acetylation by aspirin. Proceedings of the National Academy of Sciences USA 75: 5181–5184, 1978a
Burch JW, Stanford N, Majerus PW. Inhibition of platelet prostaglandin synthetase by oral aspirin. Journal of Clinical Investigation 61: 314–319, 1978b
Bye A, Lewis Y, O’Grady J. Effect of a single oral dose of aspirin on the platelet aggregation response to arachidonic acid. British Journal of Clinical Pharmacology 7: 283–286, 1979
Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina: results of a Canadian multicentre trial. New England Journal of Medicine 313: 1369–1374, 1985
Canadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. New England Journal of Medicine 299: 53–59, 1978
Catalano PM, Smith JB, Murphy S. Platelet recovery from aspirin inhibition in vivo: differing patterns under various assay conditions. Blood 57: 99–105, 1981
Cerletti C, Latini R, Dejana E, Tognoni G, Garattini S, et al. Inhibition of human platelet thromboxane generation by aspirin in the absence of measurable drug levels in peripheral blood. Biochemical Pharmacology 34: 1839–1841, 1985
Cerletti G, Livio M, De Gaetano G. Non-steroidal anti-inflammatory drugs react with two sites on platelet cyclo-oxygenase: evidence from in vivo drug interaction studies in rats. Biochimica et Biophysica Acta 714: 122–128, 1982
Chesebro JH, Clements IP, Fuster V, et al. A platelet-inhibitor-drug trial in coronary artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein graft patency. New England Journal of Medicine 307: 73–78, 1982
Chesebro JH, Fuster V, Elveback LR. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. American Journal of Cardiology 51: 1537–1541, 1983
Chesebro JH, Fuster V, Elveback LR, et al. Effect of dipyridamole and aspirin late vein-graft patency after coronary bypass operations. New England Journal of Medicine 310: 209–214,1984
Chierchia S, de Caterina R, Crea F, et al. Failure of thromboxane A2 blockade to prevent attacks of vasospastic angina. Circulation 66: 702–705, 1982
Coronary Drug Project Research Group. Aspirin in coronary heart disease. Journal of Chronic Diseases 29: 625–642, 1976
Cossum PA, Roberts MS, Kilpatrick D, Yong AC. Extrahepatic metabolism and distribution of aspirin in vascular beds of sheep. Journal of Pharmaceutical Sciences 75: 731–737, 1986
Craven J. Experiences with aspirin (acetylsalicylic acid) in the non-specific prophylaxis of coronary thrombosis. Mississippi Valley Medical Journal 75: 38–44, 1953
Crutchley DJ, Ryan US, Ryan JW. Effects of aspirin and dipyridamole on the degradation of adenosine diphosphate by cultured cells derived from bovine pulmonary artery. Journal of Clinical Investigation 66: 29–35, 1980
Cvernionke RL, Hoak JC, Fry GL. Effect of aspirin on thrombin-induced adherence of platelets to cultured cells from the blood vessel wall. Journal of Clinical Investigation 62: 847–856,1978
Dale J. Prevention of arterial thromboembolism with acetylsalicylic acid in patients with prosthetic heart valves. Abstract. Thrombosis and Haemostasis 38: 66, 1975
Dale J, Myhre E, Rootwelt K. Effects of dipyridamole and acetylsalicylic acid on platelet functions in patients with aortic ball-valve prostheses. American Heart Journal 89: 613–618,1975
Dale J, Myhre E, Storstein D, Stormorken H, Efskind L. Prevention of arterial thromboembolism with acetylsalicylic acid. A controlled clinical study in patients with substitute heart valves. American Heart Journal 94: 101–111, 1977
Davies MJ. Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. New England Journal of Medicine 310: 1137–1140, 1984
Davies MJ, Thomas AC, Knapman PA, Hangartner JR. Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation 73: 418–427, 1986
Davis HR, Vesselinovitch D, Wissler RW. Fish oil inhibits the development of atherosclerosis in Rhesus monkeys. Abstract. Circulation 74 (Suppl. 2): 1193, 1986
Davis JW, Lewis MD, Phillips PE, et al. Effects of aspirin on exercise-induced angina. Clinical Pharmacology and Therapeutics 23: 505–510, 1978
De Caterina R, Giannessi D, Bernini W, et al. Selective inhibition of thromboxane-related platelet function by low-dose aspirin in patients after myocardial infarction. American Journal of Cardiology 55: 589–590, 1985
Dechevanne M, Ville D, Viali JJ, et al. Controlled trial of platelet antiaggregating agents and subcutaneous heparin in prevention of postoperative deep venous thrombosis in high-risk patients. Haemostasis 4: 94–100, 1975
De Gaetano G, Cerletti C, Dejana E, Latini R. Pharmacology of platelet inhibition in humans, implications of the salicylate aspirin interaction. Circulation 72: 1185–1193, 1985
Dejana E, Cerletti C, DeCastellarnau C, et al. Salicylate-aspirin interaction in the rat: evidence that salicylate accumulating during aspirin administration may protect vascular prostacyclin from aspirin-induced inhibition. Journal of Clinical Investigation 68: 1108–1112, 1981
De Wood MA, Spons J, Notske MD, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. New England Journal of Medicine 303: 897–902, 1980
Di Minno G, Silver MJ, Murphy S. Monitoring the entry of new platelets into the circulation after ingestion of aspirin. Blood 61: 1081–1085, 1983
Editorial. Aspirin after myocardial infarction. Lancet 1: 1172–1173, 1980
Elwood PC. British studies of aspirin and myocardial infarction. American Journal of Medicine 74: 50–54, 1983
Elwood PC, Cochrane AL, Burr ML, et al. A randomised controlled trial of acetylsalicylic acid in the secondary prevention of mortality from myocardial infarction. British Medical Journal 1: 436–440, 1974
Elwood PC, Sweetnam PM. Aspirin and secondary mortality after myocardial infarction. Lancet 2: 1313–1315,1979
Elwood PC, Williams WO. A randomised controlled trial of aspirin in the prevention of early mortality in myocardial infarction. Journal of the Royal College of General Practitioners 29: 413–414, 1979
EPSIM Research Group. A controlled comparison of aspirin and oral anticoagulant in prevention of death after myocardial infarction. New England Journal of Medicine 307: 701–708,1982
Evans AE. Secondary prevention after myocardial infarction. Lancet 2: 150–152, 1986
Evans G, Packham MA, Nishizawa EE, Mustard JF, Murphy EA. The effect of acetylsalicylic acid on platelet function. Journal of Experimental Medicine 128: 877–894, 1968
Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 71: 699–708, 1985
Fenster PE. Do platelet-active drugs have a role in preventing reinfarction? Drug Therapy 36–44, 1982
Fields WS, Lemak NA, Frankowski M, et al. Controlled trial of aspirin in cerebral ischemia: part I. Stroke 8: 301–314, 1977
Fields WS, Lemak NA, Frankowski M, et al. Controlled trial of aspirin in cerebral ischemia, part II. surgical group. Stroke 9: 309–318, 1978
Fitzgerald DJ, Roy L, Catella F, FitzGerald GA. Platelet activation in unstable angina. New England Journal of Medicine 315: 983–989, 1986a
Fitzgerald DJ, Roy L, Catella F, FitzGerald GA. Evidence of marked platelet activation following thrombolytic therapy in acute myocardial infarction in man. Circulation 74 (Suppl II): 234, 1986b
FitzGerald GA. Dipyridamole. New England Journal of Medicine 316: 1247–1257,1987
FitzGerald GA, Oates JA. Selective and nonselective inhibition of thromboxane formation in man. Clinical Pharmacology and Therapeutics 35: 633–640, 1984
FitzGerald GA, Oates JA, Hawiger J, et al. Endogenous synthesis of prostacyclin and thromboxane and platelet function during chronic administration of aspirin in man. Journal of Clinical Investigation 71: 676–688, 1983a
FitzGerald GA, Pedersen AK, Patrono C. Analysis of prostacyclin and thromboxane A2 biosynthesis in cardiovascular disease. Circulation 67: 1174–1177, 1983b
FitzGerald GA, Smith B, Pedersen AK, Brash AR. Increased prostacyclin biosynthesis in patients with severe atherosclerosis and platelet activation. New England Journal of Medicine 310: 1065–1068, 1984
Fitzgibbon GM, Burton JR, Leach AJ. Coronary bypass graft fate: angiographic grading of 1400consecutive grafts early after operation and of 1132after one year. Circulation 57: 1070–1074, 1978
Frishman WH, Christodoulou J, Weksler B, et al. Aspirin therapy in angina pectoris: effects on platelet aggregation, exercise tolerance and electrocardiographic manifestations of ischemia. American Heart Journal 92: 3–10, 1976
Fuster V, Chesebro JH. Antithrombotic therapy: role of platelet inhibitor drugs, III: management of arterial thromboembolic and atherosclerotic disease. Mayo Clinic Proceedings 56: 265–273, 1981
Fuster V, Chesebro JH. Role of platelets and platelet inhibitors in aortocoronary vein-graft diseases. Circulation 73: 227–232, 1986
Fuster V, Steele PM, Cheseboro JH. Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. Journal of the American College of Cardiologists 5: 175B-184B, 1985
Gallus AS. Aspirin and other platelet aggregation inhibiting drugs. Medical Journal of Australia 142: 141–147, 1985
Gazes PC, Mobley EM, Faris HM, et al. Preinfarctional (unstable) angina-a prospective study-ten year follow-up: prognostic significance of electrocardiographic changes. Circulation 48: 331–337, 1973
Genton E. A perspective on platelet-suppressant drug treatment in coronary artery and cerebrovascular disease. Circulation 62 (Suppl. V): V111–121, 1980
Goldman M, Hall C, Dykes J, Hawker RJ, McCollum CN. Does 111-Indium-platelet deposition predict patency in prosthetic arterial grafts. British Journal of Surgery 70: 635–638, 1983b
Goldman MD, Simpson D, Hawker RJ, Norcott HC, McCollum CN. Aspirin and dipyridamole reduce platelet deposition on prosthetic femoropopliteal grafts in man. Annals of Surgery 108: 713–716, 1983a
Gotoh K, Katoh O, Fukui S, Hamano Y, Minamino T. Angiographic visualization of coronary thrombus during anginal attacks in unstable angina. Abstract. Circulation 72 (Suppl. 3): III 112, 1985
Green RM, Roedersheimer R, Demeeso JA. Effects of aspirin and dipyridamole on expanded polytetrafluoroethylene graft patency. Surgery 92: 1016–1026, 1982
Gunning AJ, Pickering GW, Robb-Smith AHT, Russell RR. Mural thrombosis of the internal carotid artery and subsequent embolization. Quarterly Journal of Medicine 33: 155–195,1964
Haerem JW. Sudden coronary death: the occurrence of platelet-aggregates in the epicardial arteries of man. Atherosclerosis 14: 417–432, 1971
Hamberg M, Svensson J, Samuelsson B. Thromboxanes: a new group of biologically active compounds derived from prosta-glandin endoperoxides. Proceedings of the National Academy of Sciences USA 72: 2994–2998, 1975
Hammouda MW, Moroz L. Aspirin and venous occlusion: effects on blood fibrinolytic activity and tissue-type plasminogen activator levels. Thrombosis Research 42: 78–82, 1986
Harker LA. Clinical trials evaluating platelet-modifying drugs in patients with atherosclerotic cardiovascular disease and thrombosis. Circulation 73: 206–223, 1986
Harker LA, Slichter SJ. Studies of platelet and fibrinogen kinetics in patients with prosthetic heart valves. New England Journal of Medicine 283: 1302–1305, 1970
Harker LA, Slichter SJ, Sauvage LR. Platelet-consumption by arterial prostheses: the effects of endothelialization and pharmacologic inhibition of platelet function. Annals of Surgery 186: 594–601, 1977
Harris WH, Athanasoulis CA, Waltman AC, Salzman EW. High and low-dose aspirin prophylaxis against venous thromboembolic disease in total hip replacement. Journal of Bone and Joint Surgery 64A: 63–66, 1982
Harris WH, Athanasonlis CA, Waltman AC, Salzman EW. Prophylaxis of deep-vein thrombosis after total hip replacement. Journal of Bone and Joint Surgery 67A: 58–62, 1985
Harris WH, Salzman EW, Athanasonlis CA, Waltman AC, de Sanctis RW. Aspirin prophylaxis of venous thromboembolism after total hip replacement. New England Journal of Medicine 297: 1246–1249, 1977
Harris PA, Riegelman S. Influence of the route of administration on the area under the plasma concentration-time curve. Journal of Pharmaceutical Science 58: 71–75, 1969
Hess H, Mietaschk A, Deichsel G. Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease: a prospective double-blind arteriographically controlled trial. Lancet 2: 415–419, 1985
Hetzer R, Hill JD, Kerth WJ, et al. Thromboembolic complications after mitral valve replacement with Hancock xenograft. Journal of Thoracic and Cardiovascular Surgery 75: 651–658, 1978
Hornby RI, Aintablian A, Handler M, Voleti C, Weisz D, Garvey JW, Wisoff G. Aortocoronary saphenous vein bypass grafts: longterm patency, morphology and blood flow in patients with patent grafts early after surgery. Circulation 60: 901–909,1979
Jaffe EA, Weksler BB. Recovery of endothelial prostacyclin production after low dose aspirin. Journal of Clinical Investigation 64: 532–535, 1979
Keber I, Keber D. No significant effect of chronic aspirin use on fibrinolytic response to venous occlusion in coronary patients. Thrombosis Research 39: 761–765, 1985
Kelton J, Carter CJ, Santos A, Hirsh J Sex related differences in platelet function: the effect of aspirin. Blood 59: 625–627,1982
Kelton JG, Hirsh J, Carter CJ, et al. Sex differences in the antithrombotic effects of aspirin. Blood 52: 1073–1076, 1978
Kester RC. The thrombogenicity of dacron arterial grafts and its modification by platelet inhibitory drugs. Annals of the Royal College of Surgeons of England 66: 244–246, 1984
King GL, Buchwald S. Characterization and partial purification of an endothelial cell growth factor from human platelets. Journal of Clinical Investigation 73: 392–396, 1984
Klimt CR, Knatterud GL, Stamler J, Meier P. Persantine-aspirin reinfarction study, part II: secondary coronary prevention with persantine and aspirin. Journal of the American College of Cardiologists 7: 251–269, 1986
Knudtson ML, Duff HJ, Flintoft VF, Roth DL, Hansen JL. Does short-term prostacyclin administration lower the risk of restenosis after PTCA? a prospective randomized trial. Abstract. Circulation 74 (Suppl. II): II282, 1986
Koch PA, Schultz CA, Willis AJ, Hallquist SL, Welling PG. Influence of food and fluid ingestion on aspirin bioavailability. Journal of Pharmaceutical Sciences 67: 1533–1535, 1978
Kohler TR, Kaufman JL, Kacoyanis G, et al. Effect of aspirin and dipyridamole on the patency of lower extremity bypass grafts. Surgery 9.6: 462, 1984
Lam JYT, Chesebro JH, Badimon L, Fuster V. Serotonin and thromboxane A2 receptor blockade decreases vasoconstriction but not platelet deposition after deep arterial injury. Abstract. Circulation 74 (Suppl. II): II97, 1986
Levin RI, Harpel PC, Weil D, Chang TS, Rifkin DB. Aspirin inhibits vascular plasminogen activator in vivo. Journal of Clinical Investigation 74: 571–580, 1984
Levin RI, Lovenvirth WJ, Harpel PC. Aspirin inhibits tissue plasminogen activator release and fibrinolytic activity after venous occlusion in vivo. Abstract. Circulation 74 (Suppl. II): 942,1986
Levy G. Clinical pharmacokinetics of salicylates: a reassessment. British Journal of Clinical Pharmacology 10 (Suppl 1): 2855–2905, 1980
Lewis GP, Lieberman GE, Westwick J. Potentiation of the ADP-ase activity of aortic rings by prostaglandin synthetase inhibitors and PGE1. British Journal of Pharmacology 61: 449–450, 1977
Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. New England Journal of Medicine 309: 396–403, 1983
Lewis HD, Davis JW, Archibald DG. Aspirin and the risk of myocardial infarction. New England Journal of Medicine 310: 122–123, 1984
Linos A, Worthington JW, O’Fallon W, Fuster V, Whisnaut JP, et al Effect of aspirin on prevention of coronary and cerebrovascular disease in patients with rheumatoid arthritis: a long-term follow-up study. Mayo Clinic Proceedings 53: 581–586, 1978
Liu CY, Oberle R, Fleisher D, Amidon GL. Application of a radio telemetric system to evaluate the performance of enteric coated and plain aspirin tablets. Journal of Pharmaceutical Sciences 75: 409–474, 1986
Loew D, Vinazzer H. Dose-dependent influence of acetylsalicylic acid on platelet functions and plasmatic coagulation factors. Haemostasis 5: 239–249, 1976
Lorenz RL, Schacky CV, Weber M, et al. Improved coronary artery bypass patency by low-dose aspirin (100mg daily). Lancet 1: 1261–1264, 1984
Mandelkorn JB, Wolf NM, Singh S, et al. Intracoronary thrombus in non-transmural myocardial infarction and in unstableangina pectoris. American Journal of Cardiology 52: 1–6,1983
Marcus AJ. Aspirin as an anti-thrombotic medication. New England Journal of Medicine 309: 1515–1516, 1983
Marcus AJ, Safier LB, Ulman HL, et al. Inhibition of platelet function in thrombosis. Circulation 72: 698–701, 1985
Maseri A, Chierchia S, Davies G. Pathophysiology of coronary occlusion in acute infarction. Circulation 73: 233–239, 1986
May GS, Eberlein KA, Furberg CD, Passamani ER, DeMots DL. Secondary prevention after myocardial infarction. Progress in Cardiovascular Diseases 24: 331–352, 1982
Mayer Jr JE, Lindsay WG, Castenada W, Nicoloff DM. Influence of aspirin and dipyridamole on patency of coronary artery bypass grafts. Annals of Thoracic Surgery 31: 204–210, 1981
McEnany MT, Salzman EW, Mundth ED, et al. The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts. Journal of Thoracic and Cardiovascular Surgery 83: 81–89, 1982
McKenna R, Galante J, Bachmann F, Wallace DL, Kaushal SP, et al. Prevention of venous thromboembolism after total knee replacement by high dose aspirin or intermittent calf and thigh compression. British Medical Journal 280: 514–517, 1980
Merino J, Livio M, Rajtar G, de Gaetano G. Salicylate reverses in vitro aspirin inhibition of rat platelet and vascular prosta-glandin generation. Biochemical Pharmacology 29: 1093–1096, 1980
Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. American Heart Journal 105: 351–355, 1983
Mogensen F, Knudsen JB, Rasmussen V, Kjoiler E, Gormsen J. Effect of specific thromboxane synthetase inhibition on throm-boxane and prostaglandin synthesis in stable angina induced by exercise test. Thrombosis Research 37: 259–266, 1985
Moggio RA, Hammond CL, Stansel HC, et al. Incidence of emboli with cloth-covered Starr-Edwards valves without anticoagulation and with varying forms of anticoagulation. Journal of Thoracic and Cardiovascular Surgery 75: 296–299, 1978
Mok CK, Boey J, Wang R, et al. Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial. Circulation 72: 1059–1063, 1985
Moncada S, Gryglewski R, Bunting S, Vane JR. An enzyme isolated from arteries transforms prostaglandin endoperoxides to an unstable substance that inhibits platelet aggregation. Nature 263: 663–665, 1976
Moroz L. Increased blood fibrinolytic activity after aspiriningestion. New England Journal of Medicine 296: 525–529, 1977
MRC Steering Committee. Effect of aspirin on postoperative venous thrombosis. Lancet 2: 441–445, 1972
Mustard JF, Kinlough-Rathbone RL, Packham MA. Aspirin in the treatment of cardiovascular disease: a review. American Journal of Medicine 74: 43–49, 1983
O’Brien J. Effects of salicylates on human platelets. Lancet 1: 779–783, 1968
Owens MR, Cimino CD. The inhibitory effects of sodium salicylate on synthesis of factor VII by the perfused rat liver. Thrombosis Research 18: 839–845, 1980
Packham MA. Platelet function inhibitors. Thrombosis and Haemostasis 50: 610–619, 1983
Packham MA, Mustard J. The role of platelets in the pathogenesis of atherosclerosis. Seminars in Haematology 23: 8–26, 1986
Pantley GS, Goodnight SH, Rahimtoola SH, et al. Failure of anti-platelet and anticoagulant therapy to improve patency of grafts after coronary artery bypass: a controlled, randomized study. New England Journal of Medicine 301: 962–966, 1979
Patrignani P, Filabozzi P, Patrono C. Selective, cumulative inhibition of platelet thromboxane production by low-dose aspirin in healthy subjects. Journal of Clinical Investigation 69: 1366–1372, 1982
Patrono C, Ciabattoni G, Patrignani P, et al. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation 72: 1177–1184, 1985
Patrono C, Ciabattoni G, Pinca E, et al. Low-dose aspirin and inhibition of thromboxane B2 production in healthy subjects. Thrombosis Research 17: 317–327, 1980
Pedersen AK, FitzGerald GA. Dose-related kinetics of aspirin: presystemic acetylation of platelet cyclooxygenase. New England Journal of Medicine 3.11: 1211–1214, 1984a
Pedersen AK, FitzGerald GA. Preparation and analysis ofdeuterium-labelled aspirin: application to pharmacokinetic studies. Journal of Pharmaceutical Sciences 74: 188–192, 1984b
Pedersen AK, Nowak J, FitzGerald GA. Slow administration of low dose aspirin: enhanced inhibition of platelet cyclooxygenase. Abstract. Circulation 72 (Suppl. III): 772, 1985
Pell S, Fayerweather WE. Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population. New England Journal of Medicine 312: 1005–1011,1985
Persantine-Aspirin Reinfarction Study (PARIS) Research Group. Persantine and aspirin in coronary heart disease. Circulation 62: 449–461, 1980
Pick R, Chediak J, Glick G. Aspirin inhibits the development of coronary atherosclerosis in cynomolgus monkeys (macaca ascicularis) fed an atherogenic diet. Journal of Clinical Investigation 63: 158–162, 1979
Preston FE, Emmanuel IG, Winfield DA, Malia RG. Essential thrombocythaemia and peripheral gangrene. British Medical Journal 3: 548–522, 1974
Pumphrey CW, Chesebro JH, Dewanjee MK, et al. In vivo quantitation of platelet deposition on human peripheral arterial bypass grafts using indium-III-labelled platelets: effects of dipyridamole and aspirin. American Journal of Cardiology 51: 796–801, 1983
Rahimtoola SH. Coronary bypass surgery for chronic angina —1981, a perspective. Circulation 65: 225–241, 1982
Rajah SM, Salter MCP, Donaldson DR, et al. Acetylsalicylic acid and dipyridamole improve the early patency of aortocoronary bypass grafts. Journal of Thoracic and Cardiovascular Surgery 90: 373–377, 1985
Rehders K, Simrock R, Spahn H, Mutschler E, Breddin HK. Plasma salicylate levels and platelet function after acute and chronic administration of slow-release acetylsalicylic acid (Monobeltin). European Journal of Clinical Pharmacology 27: 683–687, 1985
Reilly IAG, FitzGerald G A. Presystemic inhibition of platelet thromboxane formation by simulated slow release, low dose aspirin in man. Abstract. Clinical Research 32: 320A, 1984
Reilly IAG, FitzGerald GA. Inhibition of thromboxane formation in vivo and ex vivo: implications for therapy with platelet inhibitory drugs. Blood 69: 180–186, 1987
Reilly IAG, Roy L, FitzGerald GA. Biosynthesis of thromboxane in patients with systemic sclerosis and Raynaud’s phenomenon. British Medical Journal 292: 1037–1039, 1986
Renney JTG, Sullivan GF, Burke PF. Prevention of postoperative vein thrombosis with dipyridamole and aspirin. British Medical Journal 1: 992–994, 1976
Ribeiro PA, Zaibag M, Idris M, et al. Antiplatelet drugs and the incidence of thromboembolic complications of the St. Jude Medical aortic prosthesis in patients with rheumatic heart disease. Journal of Thoracic and Cardiovascular Surgery 91: 92–98, 1986
Ritchie JL, Stratton JR, Thiele B, et al. Indium-III platelet imaging for detection of platelet deposition in abdominal aneurysms and prosthetic arterial grafts. American Journal of Cardiology 47: 882–889, 1981
Roberts MS, McLeod LJ, Cossum PA, Vial JH. Inhibition of platelet function by a controlled release acetylsalicylic acid formation: single and chronic dosing studies. European Journal of Clinical Pharmacology 27: 67–74, 1984
Robertson, RM, Robertson D, Roberts LJ, et al. Thromboxane A2 in vasotonic angina pectoris: evidence from direct measurements and inhibitor trials. New England Journal of Medicine 304: 998–1003, 1981
Ross R. The pathogenesis of atherosclerosis — an update. New England Journal of Medicine 314: 488–500, 1986
Ross R, Glomset J. The pathogenesis of atherosclerosis. New England Journal of Medicine 295: 369–377, 420–425, 1976
Roth GJ, Majerus PW. The mechanism of the effect of aspirin on human platelets, I: acetylation of a particulate fraction protein. Journal of Clinical Investigation 56: 624–632, 1975
Roth GJ, Siok CJ. Acetylation of the NH2-terminal serine of pros-taglandin synthase by aspirin. Journal of Biological Chemistry 253: 3782–3784, 1978
Roth GJ, Stanford N, Majerus PW. Acetylation of prostaglandin synthetase by aspirin. Proceedings of the National Academy of Sciences USA 72: 3073–3076, 1975
Rowland M, Riegelman S, Harris PA, Sholkoff SD. Absorption kinetics of aspirin in man following oral administration of an aqueous solution. Journal of Pharmaceutical Sciences 61: 379–385, 1972
Russell RWR. Observations on the retinal blood vessels in monocular blindness. Lancet 2: 1422–1428, 1961
Salzman EW. Aspirin to prevent arterial thrombosis. New England Journal of Medicine 307: 113–115, 1982
Satiani B. A prospective randomized trial of aspirin in femoral popliteal and tibial bypass grafts. Angiology 36: 608–616,1985
Sauter RD, Koch EL, Myers WO, et al. Aspirin-sulfinpyrazone in prophylaxis of deep venous thrombosis in total hip replacement. Journal of the American Medical Association 250: 2649–2654, 1983
Schafer AI, Handin RI. The role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. Progress in Cardiovascular Disease XXII 1: 31–52, 1979
Sharma GV, Skuri SF, Josa M, et al. The effect of antiplatelet therapy on saphenous vein coronary artery bypass patency. Circulation 68 (Suppl. II): 1118–21, 1983
Sherman CT, Litvack F, Grundfest W, et al. Coronary angioscopy in patients with unstable angina pectoris. New England Journal of Medicine 315: 913–919, 1986
Sherry S. Effect of prostaglandin-mediated platelet-suppressant drugs on acute cardiovascular catastrophes. Advances in Prostaglandin, Thromboxane and Leukotriene Research 10: 173–210, 1982
Sherry S. Clinical aspects of antiplatelet therapy. Seminars in Hematology 22: 125–134, 1985
Siegel MI, McConnell RT, Cuatrecasas P. Aspirin-like drugs interfere with arachidonate metabolism by inhibition of the 12-hydroperoxy-5, 8, 10, 14-eicosatetraenoic peroxidase activity of the lipoxygenase pathway. Proceedings of the National Academy of Sciences USA 76: 3774–3778, 1979
Smith JB, Willis AL. Aspirin selectivity inhibits prostaglandin production in human platelets. Nature (New Biology) 231: 235–237, 1971
Sorensen PS, Pedersen H, Marquardsen J, et al. Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischemic attacks. Danish Cooperative Study. Stroke 14: 15–22, 1983
Stamatakis JD, Kakkar VV, Lawrence D, Bentley PG, Nairn D, et al. Failure of aspirin to prevent postoperative deep vein thrombosis in patients undergoing total hip replacement. British Medical Journal 1: 1031, 1978
Stamler J. Coronary heart disease: doing the ‘right things’. New England Journal of Medicine 312: 1053–1055, 1985
Steele P, Weily H, Davies H, Pappas G, Genton E. Platelet survival time following aortic valve replacement. Circulation 51: 358–362, 1975
Stratton JR, Ritchie JL. Reduction of indium-III platelet deposition on Dacron vascular grafts in humans by aspirin plus dipyridamole. Circulation 73: 325–330, 1986
Tartaglia AP, Goldberg JD, Berk PD, Wasserman LR. Adverse effects of antiaggregating platelet therapy in the treatment of polycythemia vera. Seminars in Hematology 23: 172–176,1986
Thornton MA, Gruentzig AR, Hollman J, King SB, Douglas JS. Coumadin and aspirin in prevention of reccurrence after transluminal coronary angioplasty: a randomized study. Circulation 69: 721–727, 1984
Tremoli E, Eynard A, Maderna P, Magni F, Galli G. Inhibition of platelet 12-HETE by acetylsalicylic acid (ASA): in vitro and ex vivo studies. Abstract. Thrombosis and Haemostasis 54: 242, 1985
Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nature (New Biology) 231: 232–235, 1971
Vesterquist O, Green K. Rapid recovery of in vivo prostacyclin formation after inhibition by aspirin. European Journal of Clinical Pharmacology 30: 69–73, 1986
Walenga R, Miller JL, Stuart MJ. Recovery of megakaryocyte thromboxane production in vitro after aspirin inhibition. Biochemical and Biophysical Research Communications 119: 982–988, 1984
Weily HS, Steele PP, Davies H, et al. Platelet survival in patients with substitute heart valves. New England Journal of Medicine 290: 534–537, 1974
Weiss HJ, Aledort LM, Kochwa S. The effects of salicylates on the hemostatic properties of platelets in man. Journal of Clinical Investigation 47: 2169–2180, 1968
Weksler BB, Pett SB, Alonso D, et al. Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients. New England Journal of Medicine 308: 800–805, 1983
Weksler BB, Tack-Goldman K, Subramanian VA, Gay WA. Cumulative inhibitory effect of low dose aspirin on vascular prostacyclin and platelet thromboxane production in patients with atherosclerosis. Circulation 71: 332–340, 1985
Whittle BJR, Higgs GA, Eakins KE, Moncada S, Vane J. Selective inhibition of prostaglandin production in inflammatory exudates and gastric mucosa. Nature 284: 271–273, 1980
Wiener BH, Ockene IS, Levine PH, et al. Inhibition of atherosclerosis by cod-oliver oil in a hyperlipidemic swine model. New England Journal of Medicine 315: 841–846, 1986
Willems C, deGroot PA, Pool G A, Golsalvez MS, van Aken WG, et al. Arachidonate metabolism in cultured human vascular endothelial cells: evidence of two prostaglandin synthetic pathways sensitive to acetylsalicylic acid. Biochimica et Biophysica Acta 713: 581–588, 1982
World Health Organization European Collaborative Group. European collaborative trial of multifactorial prevention of coronary heart disease: final report on the 6-year results. Lancet 1: 869–875, 1986
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Reilly, I.A.G., FitzGerald, G.A. Aspirin in Cardiovascular Disease. Drugs 35, 154–176 (1988). https://doi.org/10.2165/00003495-198835020-00005
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DOI: https://doi.org/10.2165/00003495-198835020-00005