Patients with Primary Vascular Dysregulation Benefit from Triflusal vs. ASA

SAN FRANCISCO, CA—Triflusal more effectively and consistently improved symptoms and blood flow in patients with primary vascular dysregulation (PVD) compared with acetylsalicylic acid (ASA) and should be considered a treatment option in this population, results of study presented at ACC.13, the American College of Cardiology's 62nd Annual Scientific Session have found.

Triflusal, although chemically related to ASA, “leaves intact the arachidonic acid pathway, favors the production of nitric oxide, and increases the concentration of cyclic nucleotide in endothelial cells, resulting in expanded peripheral blood vessels,” noted Sanghoon Shin, MD, from the Severance Cardiovascular Hospital, Seoul, South Korea, and colleagues. PVD is an inherited tendency to respond to stimuli such as coldness or emotional stress with inappropriate vasoconstriction or insufficient vasodilation in the microcirculation

In this double-blind, prospective, controlled, cross-over trial, the investigators randomized 88 patients with PVD to triflusal 600mg daily or ASA 300mg daily for 6 weeks, followed by cross-over. Of the patients, 54% were female and mean age was 56 years. The two primary endpoints were measured by the mean radial peak systolic velocity  (PSV) and the cold intolerance symptom severity  (CISS) questionnaire.

They defined PVD as red blood cell stand-still in video-assisted microscopic capilloscopy during cold stimulation using carbon dioxide and a score of >7 points on a validated questionnaire (from Nagashima et al., 2002). Treatment efficacy was assessed utilizing the CISS, finger Doppler indices, and indocyanine green (ICG) perfusion imaging.

Compared with baseline, “both triflusal and ASA showed improvement in CISS and PSV on finger Doppler,” Dr. Shin reported. Changes observed more prominently with triflusal than ASA were changes in CISS  (44.5 ± 18.4 vs. 51.9 ± 16.2, P<0.001) and mean radial PSV (69.8 ± 17.2 vs. 66.1 ± 16.4, P=0.011), respectively.

Incidence of CISS improvement (>10 points) was also greater with triflusal than ASA (70.8% vs. 49.4%, P<0.001). Significant differences were also observed with triflusal compared with baseline (41.9 ± 27.6 vs. 51.1 ± 27.3, P<0.001) in perfusion rate on ICG perfusion imaging; however, these were not observed with ASA.

“Triflusal 300mg twice daily can be an effective treatment with comparable antiplatelet action with usual dose aspirin in patients with PVD,” Dr. Shin concluded. “Triflusal can be a first-line treatment option to improve symptoms.”