Assess the impact of anticoagulation or antiplatelet medications on endoscopic ear surgery visibility and procedural progress.

A case–control retrospective chart review of patients on anticoagulation/antiplatelet undergoing endoscopic ear surgery from April 2018 to April 2023 was conducted. Surgical videos were blindly rated by two surgeons utilising the Modena Bleeding Scale during clips of key operative steps; scores and outcomes were compared. Equivalence analysis was performed using two one-sided tests with an equivalence range of plus-or-minus 0.4 Modena Bleeding Scale points.

Fourteen cases were matched with 28 controls. Cases were more male (85.7 per cent; p < 0.01) and older (median: 54.9 years) than controls (median: 37.8; p < 0.01). Eleven cases (78.6 per cent) were on aspirin 81 mg, two (14.2 per cent) coumadin (4–6 mg) and one (7.1 per cent) aspirin 325 mg. No significant differences in Modena Bleeding Scale, blood loss, complications or outcomes were found.

This study revealed no significant difference in intra-operative visibility, progress, complications or outcomes with patients on anticoagulation/antiplatelet. Endoscopic ear surgery may be considered while on anticoagulation/antiplatelet.

The Woven EndoBridge (WEB) device has emerged as a promising option for treating wide-neck bifurcation aneurysms. This multicenter study aimed to evaluate the impact of postoperative aspirin (ASA) use on clinical and angiographic outcomes in patients treated with the WEB device.

We conducted a retrospective multicenter study across 10 academic institutions, analyzing patients with ruptured or unruptured intracranial aneurysms treated with the WEB device.

A total of 225 patients were included, with 163 (72.4%) receiving postoperative ASA and 62 (27.6%) in the no antiplatelet (No AP) group. Before propensity score matching (PSM), the ASA group demonstrated significantly higher rates of excellent functional outcomes (mRS 0−1: 84% vs. 70%, p = 0.031) and lower mortality (3.3% vs. 13%, p = 0.014). Retreatment rates were also significantly lower in the ASA group (8.6% vs. 23%, p = 0.005). After PSM, 120 patients remained (74 ASA, 46 No AP). Retreatment rates remained significantly lower in the ASA group (5.4% vs. 24%, p = 0.003), whereas the other outcomes did not reach statistical significance after matching.

Postoperative aspirin use following WEB device treatment for intracranial aneurysms was associated with significantly lower retreatment rates, without compromising functional outcomes or mortality rates. These findings support the potential role of aspirin in enhancing aneurysm stability. Further prospective studies are needed to confirm.

This study investigated whether aspirin and atorvastatin provide additional antidepressant effects in patients with major affective disorders and inflammatory dysregulation.

Three 12-week treatment groups, each receiving aspirin (100 mg/day), atorvastatin (10 mg/day), or a placebo, were randomly assigned to 14 patients (seven with major depressive disorder [MDD] and seven with bipolar disorder [BD]), as well as two additional groups of 17 patients (each with nine patients with MDD and eight patients with BD). All patients had Clinical Global Impressions scores ≤3 and met the criteria for inflammatory dysregulation (i.e., C-reactive protein (CRP) level ≥ 1,000 ng/ml or soluble tumour necrosis factor-α receptor 1 (TNF-αR1) level ≥ 800 pg/ml). The Hamilton Depression Rating Scale (HDRS) and Montgomery-Sberg Depression Rating Scale (MADRS) were used to assess depressive symptoms, and the Global Assessment of Functioning Scale (GAF) was used to assess overall functioning. Baseline and week 12 CRP, TNF-αR1, and soluble IL-2 receptor (sIL-2R) levels were evaluated.

Generalised estimating equation models demonstrated a reduction in total HDRS (p < 0.001) and MADRS (p < 0.001) scores and an increase in GAF scores (p < 0.001) in the medication groups compared with the placebo group. Only atorvastatin increased anti-inflammatory cytokine sIL-2R levels (p < 0.001). Both atorvastatin (p < 0.001) and aspirin (p = 0.025) raised proinflammatory cytokine sTNF-αR1 levels. Discussion: Aspirin and atorvastatin improved depressive symptoms and overall function in patients with major affective disorders. However, both medications raised TNF-αR1 levels, and only atorvastatin increased sIL-2R levels.

For suspected acute myocardial infarction (AMI) and unstable angina patients, prehospital aspirin (ASA) administration has been the standard of care by Emergency Medical Services (EMS) field providers. Recently, Emergency Medical Dispatchers (EMDs), using Medical Priority Dispatch System (MPDS), provide telephone instructions to qualifying suspected AMI patients to take ASA, prior to EMS field provider arrival. No formal studies exist that measure time saved from earlier Dispatcher-Directed Aspirin Administration (DDAA).

The primary objectives of the study were: (1) to determine the amount of time saved, if any, using DDAA; and (2) to describe the frequency of DDAA and Field Provider-Directed Aspirin Administration (FPAA).

The retrospective study analyzed EMD and EMS data collected during a six-month period at three dispatch services and three EMS agencies in the United States. The frequency and mean (plus 95% confidence interval [CI]) time of DDAA and FPAA were calculated. Reasons why patients who qualified to take ASA per dispatch protocol but did not take it were also assessed.

A total of 108,459 EMS cases were analyzed; EMD/EMS delivered ASA to 4.0% (n = 4,113) of these patients. The most frequent primary impressions were: cardiac chest pain (angina), cardiovascular (CV)-chest pain (presumed cardiac), ST-segment elevation myocardial infarction (STEMI), and CV-chest pain – acute coronary syndrome (ACS; 50.0%). Overall, DDAA saved 13 minutes mean time (95% CI, 11.4-14.6; P < .001) (median: 12.3 minutes) from the case creation time.

It was found that DDAA provides measurable time savings in ASA delivery to patients. Further studies will need to assess if the reduction of ASA delivery time by EMDs has the potential to improve overall care and survival for patients. The study identified beneficial new knowledge for possible future enhancements to medical dispatch protocols and for EMS providers.

Many paediatric studies report that patients must be established on aspirin therapy for a minimum of 5 days to achieve adequate response. This is not always practical especially in critical settings. Prospective identification of patients that are unresponsive to aspirin sooner could potentially prevent thrombotic events.

The aim of this study was to investigate prospectively if the first dose of aspirin is effective in decreasing platelet aggregation, and thromboxane formation and if this can be measured after 2 hours in paediatric cardiology patients. A secondary aim was to identify a cut-off for a novel marker of aspirin responsiveness the maximum amplitude with arachidonic acid, which could potentially dramatically reduce the blood volume required. Third, we aimed to prospectively identify potentially non-responsive patients by spiking a sample of their blood ex vivo with aspirin.

The majority (92.3%) of patients were responsive, when measured 2 hours post first dose of aspirin. Non-response or inadequate response (7.7%) can also be identified at 2 hours after taking the first dose of aspirin. Additionally, we have shown a novel way to reduce blood sample volume requirements by measurement of the maximum amplitude with arachidonic acid as a marker of response, particularly for monitoring.

These findings of rapid efficacy in the majority of patients offer assurance in a sound, practical way to attending clinicians, patients, and families.

This study aimed to discuss the role of large cavity functional endoscopic sinus surgery in the management of chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

This was a retrospective review of patients undergoing large cavity functional endoscopic sinus surgery for non-steroidal anti-inflammatory drug exacerbated respiratory disease from January 2016 to March 2022. Population characteristics, pre- and post-operative number of functional endoscopic sinus surgical procedures, endoscopic polyp grade, Lund–Mackay score and nasal symptoms were recorded.

Thirteen consecutive patients with a median age of 47 years were included. They all failed maximal medical treatment and/or conservative functional endoscopic sinus surgery and underwent large cavity sinus surgery followed by post-operative maximal medical therapy. All patients showed an improvement in nasal symptoms with improved Lund–Mackay scores post-operatively. The median length of follow up was 1.5 years.

Large cavity functional endoscopic sinus surgery seems to halt the progression of chronic rhinosinusitis with nasal polyps in non-steroidal anti-inflammatory drug exacerbated respiratory disease. In this case series, large cavity functional endoscopic sinus surgery combined with optimal post-operative medical treatment appeared to switch off chronic rhinosinusitis with nasal polyps in patients with non-steroidal anti-inflammatory drug exacerbated respiratory disease.

Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis.

This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin.

The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04).

Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.

Predictors of compliance with aspirin in children following cardiac catheterisation have not been identified. The aim of this study is to identify the caregivers’ knowledge, compliance with aspirin medication, and predictors of compliance with aspirin in children with Congenital Heart Disease (CHD) post-percutaneous transcatheter occlusion.

A cross-sectional explorative design was adopted using a self-administered questionnaire and conducted between May 2017 and May 2018. Recruited were 220 caregivers of children with CHD post-percutaneous transcatheter occlusion. Questionnaires included child and caregivers’ characteristics, a self-designed and tested knowledge about aspirin scale (scoring scale 0–2), and the 8-item Morisky Medication Adherence Scale (scoring scale 0–8). Data were analysed using multivariate binary logistic regression analysis to identify predictors of compliance with aspirin.

Of the 220 eligible children and caregivers, 210 (95.5%) responded and 209 surveys were included in the analysis. The mean score of knowledge was 7.25 (standard deviation 2.27). The mean score of compliance was 5.65 (standard deviation 1.36). Child’s age, length of aspirin use, health insurance policies, relationship to child, monthly income, and knowledge about aspirin of caregivers were independent predictors of compliance with aspirin (p < 0.05).

Caregivers of children with CHD had an adequate level of knowledge about aspirin. Compliance to aspirin medication reported by caregivers was low. Predictors of medium to high compliance with aspirin were related to the child’s age and socio-economic reasons. Further studies are needed to identify effective strategies to improve knowledge, compliance with medication, and long-term outcomes of children with CHD.

Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.

In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.

There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.

High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.

Not only is depression associated with increased inflammation but inflammation is a risk factor for the genesis of depression. Many of the environmental risk factors for depression are transduced through inflammatory signaling. Anti-inflammatory agents show promise for the management of depression in preclinical, epidemiological, and early clinical studies. This opens the door to the potential for anti-inflammatory agents to treat and prevent depression. There are no evidence-based pharmacotherapies for depression prevention.

ASPREE-D, aspirin in the prevention of depression in the elderly, is a sub study of ASPREE, which explores the potential of aspirin to prevent a range of inflammation related disorders in the elderly. With a sample size of 19,114, and a duration of 5 years, this placebo controlled study will be one of the largest randomized controlled trials in psychiatry and will provide definitive evidence on the ability of aspirin to prevent depression.

This paper presents the rationale for the study and presents a summary of the study design.

ASPREE-D may not only define novel therapy but will provide mechanistic proof of concept of the role of inflammation in depression.