Targeted Research (Nov-Dec 2023)

COAGULATION & THROMBOSIS RELATED RESEARCH

1. Low-Dose Aspirin Seems to Reduce All-Cause Mortality in Cancer Patients, but Comes with an Increased Risk of GI Bleeds

ABSTRACT: Aspirin as a possible treatment of cancer has been of increasing interest for over 50 years, but the balance of the risks and benefits remains a point of contention. We summarize the valid published evidence ‘for’ and ‘against’ the use of aspirin as a cancer treatment and we present what we believe are relevant ethical implications. Reasons for aspirin include the benefits of aspirin taken by patients with cancer upon relevant biological cancer mechanisms. These explain the observed reductions in metastatic cancer and vascular complications in cancer patients. Meta-analyses of 118 observational studies of mortality in cancer patients give evidence consistent with reductions of about 20% in mortality associated with aspirin use. Reasons against aspirin use include increased risk of a gastrointestinal bleed though there appears to be no valid evidence that aspirin is responsible for fatal gastrointestinal bleeding. Few trials have been reported and there are inconsistencies in the results. In conclusion, given the relative safety and the favorable effects of aspirin, its use in cancer seems justified, and ethical implications of this imply that cancer patients should be informed of the present evidence and encouraged to raise the topic with their healthcare team.

Elwood P, et al. Aspirin and cancer treatment: systematic reviews and meta-analyses of evidence: for and against. Br J Cancer. 2023 Nov 29. doi: 10.1038/s41416-023-02506-5. Online ahead of print.

2. Further Evidence Shows Why COVID-19 Patients Have a Higher Risk of Heart Attacks and Strokes for a Prolonged Period of Time 

ABSTRACT: COVID-19 patients present higher risk for myocardial infarction (MI), acute coronary syndrome, and stroke for up to 1 year after SARS-CoV-2 infection. While the systemic inflammatory response to SARS-CoV-2 infection likely contributes to this increased cardiovascular risk, whether SARS-CoV-2 directly infects the coronary vasculature and attendant atherosclerotic plaques to locally promote inflammation remains unknown. Here, we report that SARS-CoV-2 viral RNA (vRNA) is detectable and replicates in coronary atherosclerotic lesions taken at autopsy from patients with severe COVID-19. SARS-CoV-2 localizes to plaque macrophages and shows a stronger tropism for arterial lesions compared to corresponding perivascular fat, correlating with the degree of macrophage infiltration. In vitro infection of human primary macrophages highlights that SARS-CoV-2 entry is increased in cholesterol-loaded macrophages (foam cells) and is dependent, in part, on neuropilin-1 (NRP-1). Furthermore, although viral replication is abortive, SARS-CoV-2 induces a robust inflammatory response that includes interleukins IL-6 and IL-1β, key cytokines known to trigger ischemic cardiovascular events. SARS-CoV-2 infection of human atherosclerotic vascular explants recapitulates the immune response seen in cultured macrophages, including pro-atherogenic cytokine secretion. Collectively, our data establish that SARS-CoV-2 infects macrophages in coronary atherosclerotic lesions, resulting in plaque inflammation that may promote acute CV complications and long-term risk for CV events.

Eberhardt N, et al. SARS-CoV-2 infection triggers pro-atherogenic inflammatory responses in human coronary vessels. bioRxiv. 2023 Aug 15:2023.08.14.553245. doi: 10.1101/2023.08.14.553245. Preprint

Product Q & A From Our Major Sponsor

Q: I just want to know if 4 capsules of Boluoke® would be enough to reduces a blood C-Reactive Protein of 10.5mg/L? Or can I increase the Boluoke® capsules to more per day? How long does it normally take to reduce ones blood C-Reative Protein? Dorcas H., RN  (La Mesa, CA)

A: C-RP is just an indirect way to measure Boluoke®’s effect on your system. The better way is to measure coagulation related parameters (e.g. fibrinogen, etc). If you’d like to use C-RP as a monitoring marker, the following is our suggestions:

1. Make sure there is no contraindication for the patient to take Boluoke® (lumbrokinase).

2. Start Boluoke at 2 caps 3 times daily for 4 weeks, then re-check the C-RP level.

3. If C-RP was reduced, you may continue at the same dosage (for high-risk patients) or reduce the dosage base on your clinical judgement.

4. Boluoke® is considered a crutch therapy. You should look at the underlying cause for the elevated C-RP and correct the cause. As the cause is treated/corrected, then you can reduce or stop taking Boluoke®.

Remember, most of the lumbrokinase research is based on cardiovascular patients, and its primary indication is for hypercoagulation (not simply to reduce C-RP).