Pharmacodynamic Comparison of Two Aspirin Formulations in the Caribbean: The ARC Study.

INTRODUCTION: This prospective, single-arm, crossover pharmacodynamic study assessed the effect of Bayer® low-dose enteric-coated aspirin 81 mg tablets (LD EC-ASA) (Bayer AG, Leverkusen, North Rhine-Westphalia, Germany) compared to Vazalore® low-dose phospholipid-aspirin liquid-filled 81 mg capsules (LD PL-ASA) (PLx Pharma Inc., Sparta, NJ, USA) on platelet reactivity with respect to aspirin reaction units (ARU). METHODS: Forty-seven healthy volunteers were recruited. Platelet function was evaluated with the VerifyNow™ ARU assay (Werfen, Bedford, MA, USA) and assessed post-initiation of Bayer® LD EC-ASA daily for 14 days, with a washout period of 28 days, followed by Vazalore® LD PL-ASA daily for 14 days, again followed by ARU testing. RESULTS: Participants on LD EC-ASA had a mean ARU score of 426, with 19.1% of participants having an ARU > 550; patients on LD PL-ASA derived a mean ARU score of 435, with 14.9% achieving an ARU > 550. There were no significant differences in aspirin resistance (ARU > 550) according to the formulation (Bayer® LD EC-ASA vs. Vazalore® LD PL-ASA) used. Aspirin resistance was independent of ethnicity regardless of the formulation used. In addition, there were no significant associations between body surface area (BSA) and Bayer® LD EC-ASA ARU value (p value 0.788) or Vazalore® LD PL-ASA ARU value (p value 0.477). No patients experienced any serious adverse events or treatment-emergent adverse events. CONCLUSIONS: There were no significant differences in aspirin resistance between Bayer® LD EC-ASA and Vazalore® LD PL-ASA. This dedicated pharmacodynamic study could potentially be informative and applicable for Trinidadian patients on dual antiplatelet therapy (DAPT). Further studies are required to confirm these exploratory findings. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT06228820, prospectively registered 1/18/2024.

Appropriate Implantable Cardioverter-Defibrillator Therapies Delivered 5 Years After End of Service.

We present the case of a 57-year-old man with a primary prevention internal cardioverter-defibrillator for severe nonischemic cardiomyopathy. At the time of elective replacement indicator, systolic function had fully recovered, and his generator was not changed. Nearly 5 years post-elective replacement indicator he received appropriate internal cardioverter-defibrillator therapies during a myocardial infarction. (Level of Difficulty: Intermediate.).

Clinical applications of the 810 nm diode laser in the Caribbean [abstract]

The 810 nm diode laser has many properties and applications that make it particularly suitable for use in opthalmic laser/surgical centres in the Caribbean. Microplus, subthreshold pan-retinal photocoagulation allows laser treatment for proliferative diabetic retinopathy and Central Retinal Vein Occlusion (CRVO) to be completed in a single treatment session. This is essential for patients who travel a great distance for treatment, or in whom compliance is an issue. Laser-induced chorio-retinal shunt is a possible treatment for CRVO. Trans-scleral diopexy is more effective than cryotherapy for treating peripheral retinal tears, and does not require the expense and maintenance necessitated by the use of gas cylinders. Age-related macular degeneration (ARMD) is much more common in the Caribbean than previously thought. Transpupillary thermotherapy for exudative ARMD and prophylactic grid treatment for dry ARMD are effective treatments that do not require expensive drugs and their associated side effects. Diode laser trans-scleral cyclophotocoagulation is an effective out-patient, non-surgical procedure for controlling glaucoma in patients who have failed medical management or for whom cost or a compliance issue makes medical management impractical. The size and portability of the diode laser is ideal for use and travel between different offices and surgical suites. (AU)

Treatment of diabetic retinopathy with an oral angiogenic inhibitor

Stimulation of angiogenesis has long been recognized as playing a critical role in the pathophysiology of all forms of diabetic retinopathy. Vascular endothelial growth factor (VEGF) is generally regarded as the principal angiogenic factor that leads to retinal damage in patients with diabetes. A new oral medication that specifically inhibits VEGF has been developed at Harvard Medical School's Joslin Diabetes Center. This medication is currently being evaluated in a randomised controlled multicentre trial in centres in North America and Europe involving human subjects with diabetic retinopathy. The clinical observations that led to the discovery of VEGF and the development of the oral VEGF inhibitor will be discussed. The mechanism of action of the oral inhibitor will be presented briefly. The current state of the clinical trials underway will be presented, and the implications for the clinical use of this new medication in the daily care of patients with diabetic retinopathy will be discussed.(AU)