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Aspirin

Treatment of bipolar depression with minocycline and/or aspirin: an adaptive, 2×2 double-blind, randomized, placebo-controlled, phase IIA clinical trial

“Given evidence of chronic inflammation in bipolar disorder (BD), we tested the efficacy of aspirin and minocycline as augmentation therapy for bipolar depression.

"The absence of a significant interaction between the efficacy of aspirin treatment and baseline levels of CRP and/or IL-6 may reflect Type II error given the relatively small samples, but also may reflect the clinically non-significant anti-inflammatory effect of low-dose aspirin in autoimmune or other inflammatory disorders".

"In this regard, this first report of higher baseline 11-D-TXB2 levels in the BD sample relative to the control sample (Figure S2) is noteworthy as it suggests that the activity of the arachidonic acid pathway is elevated in a subset of individuals with BD, consistent with previous hypotheses".

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Prognostic value of urinary 11-dehydro-thromboxane B2 for mortality: A cohort study of stable coronary artery disease patients treated with aspirin

"There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydrothromboxane B2 (11dhTxB2). Our data indicates the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin."

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Statin therapy and inflammation in patients with diabetes treated with high dose aspirin

"Statin and aspirin form the therapeutic cornerstone in patients with coronary artery disease and diabetes.  Little is known about relationship of statins with blood thrombogenicity and inflammation in these patients."

"Statins along with aspirin, confers additional anti-inflammatory and antithrombotic effect in diabetics with CAD. Urinary 11-DHTXB2 may be a useful biomarker for personalizing statin therapy."

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Aspirin use and reduced risk of pancreatic cancer

"Few options besides the avoidance of smoking and obesity are available to prevent pancreatic cancer.  The association between aspirin use and risk of pancreatic cancer has been inconsistent across studies.  

"Regular use of aspirin thus appears to reduce risk of pancreatic cancer by almost half."

"People who take aspirin for prevention of other diseases likely also reduce their risk of pancreatic cancer.  Aside from benefits for both cardiovascular disease and certain cancers, long term aspirin use entails some risks of bleeding complications, which necessitates risk-benefit analysis for individual decisions about use."

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Aspirin and Cancer

"The place of aspirin in primary prevention remains controversial, with North American and European organizations issuing contradictory treatment guidelines.  More recently, the U.S. Preventive Services Task Force recommended "initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50-59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years."  This recommendation reflects increasing evidence for a chemopreventive effect of low-dose aspirin against colorectal (and other) cancer.  The intent of this paper is to review the evidence supporting a chemopreventive effect of aspirin, discuss its potential mechanism (s) of action, and provide a conceptual framework for assessing current guidelines in the light of ongoing studies."

"The protective effects of low-dose aspirin against cancer appear to reflect the prevention of early neoplastic transformation throughout the alimentary tract, as well as an antimetastatic action. Both effects may be explained by the antiplatelet effect of low-dose aspirin."

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The Current and Future Landscape of Urinary Thromboxane Testing to Evaluate Atherothrombotic Risk


"Biomarker testing for efficacy of therapy is an accepted way for clinicians to individualize dosing to genetic and/or environmental factors that may be influencing a treatment regimen.  Aspirin is used by nearly 43 million Americans on a regular basis to reduce risks associated with various artherothrombotic diseases.  Despite its widespread use, many clinicians are unaware of the link between suboptimal response to aspirin therapy and increased risk for inferior clinical outcomes in several disease states, and biomarker testing for efficacy of aspirin therapy is not performed as routinely as efficacy testing in other therapeutic areas.  This article reviews the clinical and laboratory aspects of determining whole-body thromboxane production, particularly as it pertains to efficacy assessment of aspirin responsiveness."

"Aspirin use has been shown to cause a dose-dependent reduction in urinary levels of 11-dehydroTxB2."

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Platelets, cyclooxygenases and colon cancer

"A growing body of evidence supports the central role of platelets in early events of tumorigenesis and metastasis.  Activated platelets, in response to tissue damage, induce a proinflammatory program involving the aberrant expression of cyclooxygenase (COX)-2 which leads to increased tissue concentrations of the proinflammatory and protumorigenic prostaglandin E2.  The central role of platelet activation in cancer development is sustained by the analysis of clinical studies with aspiring showing an anti-cancer efficacy by the drug, even at the low doses used for the prevention of atherothrombosis."

"Activated platelets, in response to tissue damage, induce a proinflammatory program involving the aberrant expression of cyclooxygenase (COX)-2.”

“The central role of platelet activation in cancer development is sustained by the analysis of clinical studies with aspirin showing an anticancer efficacy by the drug, even at the low doses used for the prevention of atherothrombosis."

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Case-Control study of aspirin use and risk of pancreatic cancer

"Pancreas-cancer prognosis is dismal, with 5-year survival less than 5%.  Significant relationships between aspirin use and decreased pancreas-cancer incidence and mortality have been shown in four of 13 studies."

"Few Options besides the avoidance of smoking and obesity are available to prevent pancreatic cancer  The association between aspirin use and risk of pancreatic cancer has been inconsistent across studies."

"We observed a significant inverse relationship between aspirin use and risk of pancreatic cancer."

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Platelet thromboxane (11-dehydro-Thromboxane B2) and aspirin response in patients with diabetes and coronary artery disease

"Aspirin (ASA) irreversibly inhibits platelet cyclooxygenase-1 (COX-1) leading to decreased thromboxane-mediated platelet activation.  The effect of ASA ingestion on thromboxane generation was evaluated in patients with diabetes (DM) and cardiovascular disease."

“Patients with DM and CAD have significantly higher mean baseline levels of urinary 11-DHTXB2 than healthy controls likely indicating a higher platelet activation and risk for CVD.”

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Neuroblastoma-related inflammation

"The daily intake of low-dose aspirin lowers the risk of several cancers among the adults.  The continuous administration of low-dose aspirin to TH-MYCN mice (a model of pediatric neuroblastoma) delays tumor outgrowth and decreases tumor-promoting inflammation by inhibiting regulatory cells of the innate immune system as well as immunosuppressive mediators such as transforming growth factor B and thromboxane A2.  These findings pave novel avenues for the clinical management of neuroblastoma."

"The anticancer effects of aspirin have been suggested to depend on the inhibition of platelet activation, directly stemming from a reduction in TXA2 levels. This would be paralleled by a reduction in the metastatic potential of cancer cells and in the levels of COX2, by angiogenesis inhibition as well as by the attenuation of pro-inflammatory pathways involving, among several mediators, PGE2."

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