LETTER
The Effects of Aspirin on Gastric Prostaglandins
Wayne B. Jonas, MD
1 July 1994 | Volume 121 Issue 1 | Page 72
TO THE EDITOR:
The multilevel actions of aspirin and its correspondingly diverse mechanisms never cease to amaze. The hierarchical effects of aspirin on serum thromboxane B2, gastric prostaglandin E2 output, and gastric mucosal injury reported by Lee and colleagues [1] when doses as low as 3 mg/d are tested are interesting but do not tell the complete story. Studies in humans given aspirin at ultra-low doses (0.01 mg/d) show a paradoxical decrease in template bleeding time that is transient but significant [2, 3]. This effect is not caused by increased platelet aggregation but is modulated by factors in the vascular wall endothelium (probably prostacyclin) [4]. Thus, vascular wall effects should be added to the bottom level of the aspirin-effect hierarchy.
Although sex differences may not exist in the rate of mucosal damage from aspirin, bleeding time and platelet aggregation do show such differences [5]. Lee and associates have done us a service by showing that less may not only be less but also different. Very-low-dose aspirin used as prophylactic therapy could decrease serum levels of aspirin into the ultra-low-dose range, paradoxically producing decreased bleeding times and an increased potential for thrombotic events. Before long-term clinical trials are initiated, more evaluation of the effects of aspirin at very-low and ultra-low doses in both sexes is needed.
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Author and Article Information
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Walter Reed Army Institute of Research; Washington, DC 20307-5100
1. Lee M, Cryer B, Feldman M. Dose effects of aspirin on gastric prostaglandins and stomach mucosal injury. Ann Intern Med. 1994; 120:184-9.
2. de Gaetano G, Cerletti C. Prolongation of bleeding time by aspirin: a dual mechanism? Thromb Res. 1988; 50:907-120.
3. Doutremepuich C, de Seze O, Le Roy D, Lalanne MC, Anne MC. Aspirin at very ultra low dosage in healthy volunteers: effects on bleeding time, platelet aggregation and coagulation. Haemostasis. 1990; 20:99-105.
4. Lalanne MC, Doutremepuich C, de Seze O, Belon P. What is the effect of acetysalicylic acid at ultra low dose on the interaction platelets/vessel wall? Thromb Res. 1990; 60:231-6.
5. Buchanan MR, Rischke JA, Butt R, Turpie AG, Hirsh J, Rosenfeld J. The sex-related differences in aspirin pharmacokinetics in rabbits and man and its relationship to antiplatelet effects. Thromb Res. 1983; 29:125-39.
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