DOI: 10.5176/2345-783X_PHARMA17.37
Authors: Abubakar Sha’aban, Hadzliana Zainal and Baharudin Ibrahim
Abstract:
The use of low-dose aspirin (LDA) has become the cornerstone of secondary prevention in coronary heart disease. It has been proven to reduce the risk of new atherothrombotic event through platelet inhibition. Despite the demonstrated beneficial effects of LDA, it has the negative effect of increasing the risk of gastro-intestinal tract (GIT) toxicity. The toxicity may range from troublesome symptoms without mucosal lesions to more serious toxicity, including ulcers, GI bleeding, and perforation. Aspirin is thought to cause gastric damage by both topical irritant effects on the epithelium and more importantly by systemic effects related to suppression of mucosal prostaglandin synthesis. There is substantial evidence supporting the hypothesis that systemic effects are the major component of the mechanism underlying the pathogenesis of LDA-induced gastric ulcers as opposed to topical injury. Several efforts have been made to personalise therapy of LDA based on GIT toxicity. The aspirin cardiovascular/ gastrointestinal risk calculator was developed to assist in estimating cardiovascular (CV) and gastrointestinal (GI) risks to facilitate the clinical decision-making process. Some researchers tried to identify genetic factors associated with LDA-induced gastrointestinal toxicities. They found several single nucleotide polymorphisms that are thought to be associated with the GIT toxicities. Others attempted metabolomic profiling of stomach extract and serum from rats to identify biomarkers for such toxicities. These will need further validation in humans. Pharmacometabonomics have been exploited in terms of response variability to LDA, but studies have not been identified that tried using the concept to explore its GIT toxicities. This review aimed to review the literature to highlight the landmarks achieved in personalising LDA therapy based on GIT toxicity and identify the gaps available for future research.
Keywords: low-dose aspirin, gastrointestinal, toxicity, personalise therapy
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