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Aspirin efficacy in Vernal Keratoconjunctivitis

A comparative study on the role of Aspirin in Vernal Keratoconjunctivitis by M. Shakaib Anwar1 has showed significant reduction (70%) in itching, lacrimation, limbal edema and had improved photophobia with reduction in size of the palpebral lesions and corneal staining.

 In group I, patients were given topical preparations of 2% cromolyn sodium and 2% fluorometholone, to be instilled thrice a day. In group II, oral aspirin was added to the above regime. 2% fluorometholone was tapered off over two weeks, while aspirin was continued for four to eight weeks and 2% cromolyn sodium continued for the rest of the period. Group III, received a placebo. In the patient with vernal ulcer, a prophylactic antibiotic cover with topical preparation of ciprofloxacin was given for initial two weeks. The dosage for aspirin was adjusted at the rate of 25 mg per kg of body weight. Informed consent was taken from all the patients regarding the study program. Regular follow-up visits were arranged weekly for the first two weeks, fortnightly for two month and then monthly for six months to one year.

 After 2nd week of therapy patients in Aspirin group were still better showing an overall reduction in symptoms of about 85%. After four & six weeks treatment group I & group II showed 90-93% and 95-98% reduction in their symptoms respectively.

 VKC is basically an allergic disorder in which IgE (humoral) and cell mediated immune mechanisms play a vital role. Corticosteroids inhibit the production of prostaglandins by inhibiting the conversion of phospholipids to arachidonate in the initial stage by inducing an inhibitory lipocortin and also inhibiting the induction of cyclooxygenase which is vital for conversion of arachidonate to prostaglandin in the final stage. Aspirin also acts at this final stage and inhibits prostaglandin production. It can reduce the duration of topical corticosteroid use or even replace it when combined with topical sodium cromomglycate. Therefore, its use is recommended especially in the first four to eight weeks along with 2% sodium cromoglycate, which can alone be continued later on, while topical corticosteroids can be added in severe cases only in the initial one to two weeks to reduce discomfort and make the patients more compliant. Hypersensitivity to aspirin, bleeding disorder and peptic ulcer are some of the contra indications for aspirin therapy. These conditions should be ruled out before using Aspirin.

 Reference:
1. Anwar MS. The role of aspirin in vernal keratoconjunctivitis. J Coll Physicians Surg Pak 2003; 13(3):178-179.


Aspirin use after coronary artery bypass graft surgery

Initiation of Aspirin therapy within 48 hours among patients who underwent coronary artery bypass graft surgery (CABG) resulted in significant reduction in mortality as well as other events.

This study was conducted at 70 centers in 17 countries. The authors prospectively studied 5065 patients undergoing coronary bypass surgery of whom 5022 survived the first 48 hours after surgery. Their primary focus was to discern the relation between early aspirin use, fatal and non-fatal outcomes.  

Patients who received Aspirin (upto 650mg) after revascularization, subsequent mortality was 1.3% (40 of 2999 patients) as compared with 4.0% among those who did not receive Aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with 48% reduction in the incidence of myocardial infarction, 50% reduction in the incidence of stroke, a 74% reduction in the incidence of renal failure and a 62% reduction in the incidence of bowel infarction. Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use.

Conclusion

The authors of the study have concluded that early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys and gastrointestinal tract.

Reference

1. Mangano DT. Aspirin and mortality from coronary bypass surgery. Multicenter study of perioperative ischemia Research Group. N Eng J Med. 2002; 347(17): 1309-1317.

Further reading

Topol EJ. Aspirin with Bypass Surgery From Taboo to New standard of Care. N Eng J Med 2002; 347(17):1359-1360.

 

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