. . . but a different site of absorption–with greater predictability than ECASA. DON’T MISS IT!! @DLBHATTMD @cpcannon @AnnMarieNavar @DrM_ODonoghue @DrMarthaGulati @practicalcardio @GuyattGH @DrMauricioCohen @SVRaoMD @ASPCardio @PlateletDoc @stephanamayer #FOAMed #CardioTwitter pic.twitter.com/2ATbM9g51F
— cardio-met (@cardiomet_CE) November 8, 2021
2) This tweetorial is supported by an educational grant from PLx Pharma, and is intended for healthcare professionals. Faculty disclosures are listed at https://t.co/gvXca4G9Xm and similar programs on #antiplatelets, still available for credit, are at https://t.co/WfqOL6AhBw.
— cardio-met (@cardiomet_CE) November 9, 2021
4) … that aspirin use for the primary prevention of CVD events in adults ages 40-59y who have a 10%+ 10-year CVD risk has a SMALL net benefit, and that initiating #ASA use for primary prevention of CVD events in adults age 60+ has NO net benefit. This is because …
— cardio-met (@cardiomet_CE) November 9, 2021
6) Unfortunately, press around these guidelines was interpreted too broadly and was applied by many well-meaning patients to their high-risk situation, as well as those on ASA for #secondaryprevention, which the guidelines don’t address at all! See https://t.co/qbL2rHun6J
— cardio-met (@cardiomet_CE) November 9, 2021
8) … upstream block of prostanoid biosynthesis and, ultimately, inhibition of thromboxane A2 (TXA2) and prostacyclin (PGI2) generation. Mature platelets express only COX-1 & produce TXA2 in response to many stimuli. Vascular endothelial cells express both COX-1 & COX-2 …
— cardio-met (@cardiomet_CE) November 9, 2021
10) Long story short: pic.twitter.com/8sAtL6RQPl
— cardio-met (@cardiomet_CE) November 9, 2021
12) You can’t give a pt an #antithrombotic without ⬆️bleeding risk over baseline. But some patients (think high-risk primary #CVD prevention and many secondary CVD prevention pts) NEED an #antithrombotic effect. It’s a positive benefit:risk balance! But if they DON’T TAKE IT …
— cardio-met (@cardiomet_CE) November 9, 2021
14) So if selected patients benefit from ASA, but don’t take it because of GI upset, what can we do? Lower dose? Doesn’t yield effective platelet inhibition. Longer interval between doses? Same. Enteric coating? GI absorption–and therefore effect–is erratic.
— cardio-met (@cardiomet_CE) November 9, 2021
16) So what if we could complex ASA with phospholipids (PL-ASA) and thereby maintain gastric hydrophobicity? Animal models suggest that in this case ASA exposure to GI lumen would be largely delayed until it exits the stomach. pic.twitter.com/M4HT4luiJD
— cardio-met (@cardiomet_CE) November 9, 2021
Mark your answer!
— cardio-met (@cardiomet_CE) November 9, 2021
19) Welcome back! We are talking #ASA for #cardiovascular event risk reduction & changing the pill so that the risk of GI injury is reduced. This is your source for CE/#CME-accredited, serialized education on Twitter! I am @CMichaelGibson.
— cardio-met (@cardiomet_CE) November 10, 2021
21) … post-stomach) & “plain” ASA (black line, absorbed in stomach) overlap. For you #PK geeks, AUC of plasma conc’s after 325 mg dosing were: PL-ASA (2523), plain ASA (1964), ECASA (456). So yes, it’s absorbed. Is there less injury to the gastric mucosa w/ PL-ASA? Take a look: pic.twitter.com/YkGFdESmdu
— cardio-met (@cardiomet_CE) November 10, 2021
23) So, it appears that PL-ASA might help reduce GI injury in chronic use, whether part of #DAPT or not. That’s critical, whether after #ACS/#PCI or after #stroke/#TIA, especially during the early “vulnerable” periods during which the #antithrombotic effect ..
— cardio-met (@cardiomet_CE) November 10, 2021
25) Because in this #tweetorial we are talking primarily about secondary prevention (see what I did there??), which isn’t provided with 325mg like these data we have considered. We use 81mg! Will the absorption and the effect be similar to ECASA at a low dose?
— cardio-met (@cardiomet_CE) November 10, 2021
27) Take your best shot: what did they find?
— cardio-met (@cardiomet_CE) November 10, 2021
(a) faster absorption PL-ASA > ECASA
(b) more complete absorption PL-ASA > ECASA
(c) less potent inhibition of #platelet aggregation PL-ASA < ECASA
(d) a & b
28) Mark your response and return tomorrow for the answer, a wrap-up of this program, and your link to FREE CE/#CME—#physicians #nurses #Pharmacists #PAs #NPs. Nod to @mvaduganathan @hvanspall @HannahBeba @JavedButler1 @JJheart_doc @AmitGoyalMD @cardiojaydoc02 @DBelardoMD
— cardio-met (@cardiomet_CE) November 10, 2021
30) So let's quickly review. Plain ASA is assoc'd with risk of mucosal damage in the UGI tract. Enteric coated aspirin (ECASA) was designed to ⬇️GI injury (and thereby ⬆️tolerance and 🤞hopefully ⬆️ adherence by bypassing stomach & releasing ASA in …
— cardio-met (@cardiomet_CE) November 11, 2021
32) … be absorbed like plain ASA but in the duodenum. Seems to work with a 325mg dose. What about 81mg? Let's look at the PK findings from @TCTConference presentation: pic.twitter.com/vvvjyrgD0u
— cardio-met (@cardiomet_CE) November 11, 2021
34) So, let's summarize: The ongoing (occasionally heated) discussion abt #ASA for primary prevention of #CV events in MOST patients is a subject for another #tweetorial. The use of #ASA 81mg for secondary prevention–at least early on after #ACS/#PCI or ischemic stroke/#TIA …
— cardio-met (@cardiomet_CE) November 11, 2021
36) … an inhaled nanoparticle ASA prep, admin'd with a dry powder inhaler & an ASA-loaded solid lipid microparticle formulation, but those aren't in the clinic anytime soon–if ever. PL-ASA is a novel, FDA-approved phospholipid-ASA formulation in a liquid-filled capsule …
— cardio-met (@cardiomet_CE) November 11, 2021
38) … less GI injury + great PK&PD … does that equate to better adherence and potentially better outcomes? pic.twitter.com/5XrLaEVexR
— cardio-met (@cardiomet_CE) November 11, 2021
39) And that's it! You made it! Claim your 0.5h CE/#CME at https://t.co/MlG6ZEiGEb now, & FOLLOW US for more accredited #tweetorials in #cardiometabolic medicine! Also JOIN US at @ckd_ce for more FREE credit focused on–you guessed it–#CKD! Til next time, I am @CMichaelGibson.
— cardio-met (@cardiomet_CE) November 11, 2021