Rh. Boger et al., RAPID AND SELECTIVE-INHIBITION OF PLATELET-AGGREGATION AND THROMBOXANE FORMATION BY INTRAVENOUS LOW-DOSE ASPIRIN IN MAN, Clinical science, 84(5), 1993, pp. 517-524
1. One of the major problems in the clinical use of low dose aspirin f
or the prevention of vascular occlusion is that it takes about 3-5 day
s to become effective, a time too long for patients with unstable angi
na or coronary thrombolysis. Intravenous aspirin may be expected to ex
ert a more rapid effect, but its influence on endothelial prostacyclin
synthesis is uncertain. 2. In a single-blind, randomized, prospective
study, we compared the effects of a single intravenous low dose (50 m
g) or high dose (500 mg) of aspirin or placebo infused over a 60 min p
eriod on platelet aggregation, platelet thromboxane A2 production and
whole-body prostanoid synthesis in 10 healthy male subjects by gas chr
omatography-tandem mass spectrometry. 3. Before the study, blood flow
rates in the basilic and subclavian veins were determined by sonograph
ic colour velocity imaging; the infusion rate for low dose aspirin was
calculated to avoid biologically effective plasma levels of aspirin i
n the systemic circulation. 4. Platelet aggregation induced by 1 mmol/
l arachidonic acid was similarly inhibited by >85% within 30 min after
the start of the infusion of high dose or low dose aspirin, respectiv
ely, and remained suppressed for 24 h. Platelet thromboxane A2 release
declined gradually after low dose aspirin, reaching a minimum of 93%
inhibition after 60 min. High dose aspirin suppressed platelet thrombo
xane A2 release to below the detection limit after 10 min. 5. Urinary
excretion of the major urinary metabolite of thromboxane A2 (2,3-dinor
-thromboxane B2) WaS equally suppressed by both dosages of aspirin [no
significant difference between high dose (-83.2%) and low dose (-67.4
%)]. The urinary excretion of the major urinary metabolite of prostacy
clin (2,3-dinor-6-keto-prostaglandin F1alpha) and of prostaglandin E2
was also markedly decreased, by 79.2% and 63.5%, respectively, by high
dose aspirin, whereas low dose aspirin suppressed 2,3-dinor-6-keto-pr
ostaglandin F1alpha excretion significantly less (-30.3%; P<0.02), and
had no inhibitory effect at all on prostaglandin E2 excretion, indica
ting that after intravenous low dose aspirin no biologically active ac
etylsalicylate was present in the systemic circulation. 6. These data
show that intravenous low dose aspirin can inhibit platelet aggregatio
n and thromboxane B2 synthesis within less than 2 h while sparing syst
emic cyclo-oxygenase activity. Partial inhibition of prostacyclin form
ation seems to be an unavoidable consequence of effective inhibition o
f platelet cyclo-oxygenase by aspirin.