Resumen
Conocido desde la antiguedad el ácido acetil salícilico (ASA), se utilizó primero como analgésico y en tiempos reci- entes como antiagregante plaquetario. Su indicación en el ataque cerebrovascular agudo (ACV) y en la prevención de la enfermedad cerebrovascular, descansa sobre estudios realizados con grupos asignados al azar y meta-análisis de reciente realización. Su uso en combinación con otras medicamentos antiagregantes se ha probado en ensayos de adecuado diseño, en grandes estudios multicéntricos con asignación al azar y controlados con medicación estándar.
Al momento la prescripción de ASA en el ACV isquémico agudo debe iniciarse tan pronto el paciente pueda deglutir el medicamento. En prevención secundaria de ACV, no cardioembólico, su adecuada prescripción (100-325 mg/día) constituye elemento de buena práctica médica. En pacientes con fibrilación auricular crónica que no pueden antico- agularse, por contraindicación establecida, solo o en combinación con clopidogrel es una alternativa menos segura pero útil. Su combinación con dipiridamol de liberación controlada, es otra alternativa en prevención secundaria.
La resistencia a la aspirina requiere la exclusión de falla del tratamiento y no parece ser un hallazgo frecuente en la población general.
Citas
Gensini GF, Conti AA. The preventive and thera- peutic impact of antiplatelet agents: past and present. Minerva Med 2009;100:133-136.
Pérez-Cajaraville J, Abejón D, Ortiz JR, Pérez JR. El dolor y su tratamiento a través de la historia. Rev. Soc. Esp. Dolor 2005; 12: 373-384.
Quevedo E, Pérez GE, Miranda N; Eslava JC, Hernández M. Bustos L, Durán MF, et al. Historia de la Medicina en Colombia. Cali: Editorial Norma- Tecnoquícas SA 2008;50-57
Brañal MF, Del Río LA, Trives C, Salazar N. La ver- dadera historia de la Aspirina. Anales Real. Academia Nacional de Farmacia 2005;71: 813-819
Luwig Fleck. La génesis de un hecho científico. Madrid: Editorial Alianza 1986.
Sneader W. The discovery of aspirin: a reappraisal.
Br Med J 200;32:1591-1594.
Castillo J, Rodríguez JR, Suárez C. Ácido acetil- salicílico. En Castillo J, Martínez-Villa E eds. Trom- bosis, Fármacos Antitrombóticos y Enfermedad Cerebrovascular. Barcelona: Gráficas Boada, S.L- J. Uriach y Cia, S.A.1995:175-192.
Maalouf R, Mosley M, James Kallail K, Kramer KM, Kumar G. A comparison of salicylic acid levels in normal subjects after rectal versus oral dosing. Acad Emerg Med 2009;16:157-61.
Needs CJ, Brooks PM. Clinical pharmacokinetics of the salicylates. Clin Pharmacokinet 1985;10:164-77.
Cipollone F, Fazia ML. COX-2 and atherosclerosis. J Cardiovasc Pharmacol 2006;47 Suppl 1:S26-36.
Santovito D, Mezzetti A, Cipollone F. Cyclooxy- genase and prostaglandin synthases: roles in plaque stability and instability in humans. Curr Opin Lipidol 2009;20:402-408.
Piletta P, Porchet HC, Dayer P. Central analgesic effect of acetaminophen but not of aspirin. Clin Pharmacol Ther 1991;49:350-3544.
Kao TY, Huang WT, Chang CP, Lin MT. Aspirin may exert its antipyresis by inhibiting the N-methyl- D-aspartate receptor-dependent hydroxyl radi- cal pathways in the hypothalamus. J Pharmacol Sci 2007;103:293-288.
Tsimihodimos V, Psychogios N, Kakaidi V, Bairak- tari E, Elisaf M. Salicylate-induced proximal tubular dysfunction. Am J Kidney Dis 2007;50:463-7.
Kao TY, Huang WT, Chang CP, Lin MT. Aspirin may exert its antipyresis by inhibiting the N-methyl- D-aspartate receptor-dependent hydroxyl radi- cal pathways in the hypothalamus. J Pharmacol Sci 2007;103:293-8.
Moreno Alvarez PJ, Madurga Sanz M. Drug safety. Notes regarding drug surveillance. Farm Hosp 2003;27:331-335.
Pearlman BL, Gambhir R. Salicylate intoxication: a clinical review. Postgrad Med 2009; 121:162-168.
Stevenson DD, Szczeklik A.Clinical and patho- logic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006;118:773-86; quiz 787-8.
The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or nei- ther among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet 31;349(9065):1569-1581.
CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet 1997 Jun 7;349 (9066):1641-9.
Chen ZM, Sandercock P, Pan HC, Counsell C, Col- lins R, Liu LS, Xie JX, Warlow C, Peto R. Indications for early aspirin use in acute ischemic stroke : A com- bined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collab- orative groups. Stroke. 2000;31:1240-1249.
Sandercock PA, Counsell C, Gubitz GJ, Tseng MC. Cochrane Database Syst Rev 2008;(3):CD000029.
A randomized trial of aspirin and sulfinpyrazone in threatened stroke. The Canadian Cooperative Study Group. N Engl J Med 1978;299:53-59.
Frank L Silver, Vladimir Hachinski, G Patrick Clagett, R Barnes, J David Spence, for the ASA and Carotid Endarterectomy Collaborators. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial (ACE) Trial. Lancet 1999; 353: 2179–84.
Collaborative overview of randomised trials of antiplatelet therapy I: Prevention of death, myocar- dial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ 1994;308(6921):81-106.
Collaborative overview of randomised trials ofan- tiplatelet therapy-II: Maintenance ofvascular graft or arterial patency by antiplatelet therapy. Antiplatelet Trialists’ Collaboration. BMJ 1994;308 (6921):159-
Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myo- cardial infarction, and stroke in high risk patients. BMJ 2002 12;324(7329):71-86.
Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, Hennekens CH, Buring JE. A ran- domized trial of low-dose aspirin in the primary pre- vention of cardiovascular disease in women. N Engl J Med 2005;352(13):1293-1304.
Hart RG, Halperin JL, McBride R, Benavente O, Man-Son-Hing M, Kronmal RA. Aspirin for the pri- mary prevention of stroke and other major vascular events: meta-analysis and hypotheses. Arch Neurol 2000;57:326-332.
Fowkes GR, Price JF, Stewart MC, Butcher I, Leng GC, Pell AC, Sandercock PA, et al, for the Aspi- rin AsymptomaticAtherosclerosis Trialists. Aspirin for Prevention of Cardiovascular Events in a Gen- eral Population Screened for a Low Ankle Brachial Index A Randomized Controlled Trial. JAMA 2010;303:841-848.
Barnett HJ, Eliasziw M. Aspirin benefit remains elusive in primary stroke prevention. Arch Neurol 2000;57:306-308.
Cañivano Petreñas L, García Yubero C. Resistance to aspirin: Prevalence, mechanisms of action and association with thromboembolic events. A narrative review. Farm Hosp 2010;34:32-43.
Tantry US, Mahla E, Gurbel PA. Aspirin resistance. Prog Cardiovasc Dis 2009;52:141-152.
Kasotakis G, Pipinos II, Lynch TG Current evi- dence and clinical implications of aspirin resistance.J Vasc Surg 2009;50:1500-1510.
Goodman T, Ferro A, Sharma P. Pharmacogenet- ics of aspirin resistance: a comprehensive systematic review. Br J Clin Pharmacol 2008;66:222-232.
Skliut M, Jamieson DG. Update on antiplate- let agents, including MATCH, CHARISMA, and ESPRIT. Curr Cardiol Rep 2008;10:9-16.
Goodman T, Ferro A, Sharma P. Pharmacogenet- ics of aspirin resistance: a comprehensive systematic review. Br J Clin Pharmacol 2008;66:222-32.
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