AAS e o Tromboembolismo
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Transcript of AAS e o Tromboembolismo
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Discussant of:Does Aspirin Intake at Bedtime DecreaseBlood Pressure and Morning Peak of Platelet
Reactivity?: A Randomized Cross-over TrialT.N. Bonten, J.D. Snoep, W.J. Assendelft, J.J. Zwaginga, J.
Eikenboom, M.V. Huisman, F.R. Rosendaal, J.G. van der BomLeiden University Medical Center, the Netherlands
William C. Cushman, MD, FAHAChief, Preventive Medicine
Memphis Veterans Affairs Medical Center
Professor, Preventive Medicine, Medicine, Physiology
University of Tennessee Health Science Center
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Fig 3. Changes in circadianpattern of BP and HR afteraspirin (100 mg/d) administered
before bedtime in patients withmild hypertension sampled by48-hour ambulatory monitoring.
Hermida R et al. Hypertension 2003;41:1259-1267Copyright American Heart Association
On no AHT meds
Mean age: 42 yearsOffice BP: 147/86 mm Hg
PM dosing (n=26): -6/4 mmHg, p
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Aspirin HS vs Awakening:BP Comments/Questions
Trial is relatively large for ABPM outcomes (strength). Appears to be well designed and conducted.
How do the authors explain the difference in these ABPM
results vs BP reductions seen with HS aspirin in previous
studies? In Hermida, et al, participants were untreated/on no
antihypertensive meds
Age mean 42 vs 64 years
BP mean 147/86 vs 137/88 mm Hg N 26 vs 145 in HS dosing groups
What % of current study were on no AHT medications?
Do authors believe it matters when aspirin is dosed?
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Bonten, et al: Effect of PM vs AM dosing on AMPlatelet Reactivitiy (ARU)
About 5%Difference inARU
Level reported as indicting aspirin resistance = 550 ARU
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Aspirin HS vs Awakening:Platelet Reactivity Comments/Questions
Although VerifyNow ARU (Aspirin Reaction Units) isreduced in the morning with HS vs Awakening dosing,how do the authors know the effect of HS or AMdosing on ARU at other times of the day?
Is this 5% difference in mean VerifyNow ARU clinicallyimportant? Both means are within a clinicallyacceptable range.
Is VerifyNow ARU the most reliable/appropriateassessment of platelet aggregability?
Should this hypothesis-generating information betested in a RCT or other analyses? How?
