Effect of Deuterated Aspirin Treatment of Obese Iraqi Patients With Blood Hyperviscosity Syndrome

  • Sura Q Al-Kinany Department of Chemistry, College of Science, Mustansiriyah University, Baghdad, Iraq
  • Fatin Fadhel Mohammed Al-Kazazz Department of Chemistry, College of Science, Mustansiriyah University, Baghdad, Iraq. https://orcid.org/0000-0002-1286-2797
  • Hussein Inayah Department of Chemistry, College of Science, Mustansiriyah University, Baghdad, Iraq. https://orcid.org/0000-0002-7045-656X
  • Wasan AM Al Taie Department of Biotechnology, School of Arts & Sciences, American University of Ras Al Khaimah, Ras Al Khaimah, United Arab Emirates. Department of General Education, School of e-Education, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates. Emirates Chemical Society, Ras Al Khaimah, United Arab Emirates. eEmirates Clinical Chemistry Society, Emirates Medical Association, Dubai, United Arab Emirates https://orcid.org/0000-0003-3298-8351
Keywords: Aspirin, Blood viscosity, Deuteration, Hydrogen/Deuterium exchange, Hyperviscosity syndrome

Abstract


Background/Aim: Hyperviscosity syndrome (HVS) is a predictor of blood flow resistance and blood viscosity, density, or thickness. A number of factors that influence blood viscosity have been identified. This study aimed to compare the effects of the deuterated aspirin (aspirin-D) to standard aspirin (aspirin-H) on the prothrombin time (PT) and the normalised international ratio (INR) in obese HVS patients and healthy individuals of normal weight. Haematocrit (HCT) was the primary determinant of blood viscosity and flow resistance.

Methods: The study included 120 Iraqi individuals, aged between 21 and 55 years, divided into 2 groups, 60 patients in an obese HVS group and 60 in a healthy weight control group. Total complete blood count, haemoglobin (Hb), the effects of aspirin-H and aspirin-D on blood viscosity were evaluated by measuring HCT, red blood cell (RBC), PT and INR.

Results: Patients aged 31–41 years with a body mass index (BMI) of 30–39.9 kg/m² constituted the largest proportion of the HVS group (41.66 %), while the same age group represented the highest percentage among healthy controls (40 %). Patients with HVS showed highly significant increases (p < 0.001) in anthropometric and haematological parameters, including BMI, Hb, HCT and RBC, along with a significant reduction in PT and INR compared to controls. Aspirin treatment, particularly deuterated aspirin, significantly increased PT and INR values, indicating improved anticoagulant activity.

Conclusion: Aspirin-D was superior to standard aspirin-H in reducing blood viscosity and delaying clotting time in both HVS patients and healthy subjects.

References

Kucukal E, Man Y, Hill A, Liu S, Bode A, An R, et al. Whole blood viscosity and red blood cell adhesion: potential biomarkers for targeted and curative therapies in sickle cell disease. Am J Haematol. 2020;95:1246–56. doi: 10.1002/ajh.25933.

Kim BJ, Lee YS, Zhbanov A, Yang S. A physiometer for simultaneous measurement of whole blood viscosity and its determinants: haematocrit and red blood cell deformability. Analyst. 2019;144:3144–57. doi: 10.1039/c8an02135j.

Weaver A, Rubinstein S, Cornell RF. Hyperviscosity syndrome in paraprotein secreting conditions including Waldenström macroglobulinemia. Front Oncol. 2020;10:815. doi: 10.3389/fonc.2020.00815.

Al Kuraishy HM, Al Gareeb AI, Al Hamash SM, Cavalu S, El Bouseary MM, Sonbol FI, et al. Changes in the blood viscosity in patients with SARS CoV 2 infection. Front Med (Lausanne). 2022;9:876017. doi: 10.3389/fmed.2022.876017.

Gertz MA. Acute hyperviscosity: syndromes and management. Blood. 2018;132:1379–85. doi: 10.1182/blood-2018-06-846816.

Li K, He C. Gastric mucosal lesions in Tibetans with high altitude polycythemia show increased HIF 1A expression and ROS production. Biomed Res Int. 2019;2019:6317015. doi: 10.1155/2019/6317015.

Sultan AR, Al Kazazz FFM, Mohammed AH. Impact of magnesium oxide nanoparticles on erythropoietin hormone levels in sera of patients with anemia accompanied with diabetic kidney disease. Nano Biomed Eng. 2020;12:232–40. doi: 10.5101/nbe.v12i3.p232-240.

Al Kazazz FFM, Jaber SH, Mohammed AH, Abdullah AH, Kadhim MM, Sultan AR. Preparation of magnesium oxide nanoparticles and study its loaded with recombinant human erythropoietin alfa drug. Nano Biomed Eng. 2022;14:186–91. doi: 10.5101/nbe.v14i2.p186-191.

Dimitrokalli E, Fertaki S, Lykouras M, Kokkinos P, Orkoula M, Kontoyannis C. Warfarin sodium stability in oral formulations. Molecules. 2021;26:6631. doi: 10.3390/molecules26216631.

Abdelghani E, Cua CL, Giver J, Rodriguez V. Thrombosis prevention and anticoagulation management in the pediatric patient with congenital heart disease. Cardiol Ther. 2021;10:325–48. doi: 10.1007/s40119-021-00228-4.

Mladentsev DY, Kuznetsova EN, Skvortsova MN, Dashkin RR. Review on synthetic approaches toward rivaroxaban (Xarelto), an anticoagulant drug. Org Process Res Dev. 2022;26:2311–29. doi: 10.1021/acs.oprd.2c00188.

Dimond M, Looby M, Shah B, Sinha SS, Isseh I, Rollins AT, et al. Design and rationale for the direct oral anticoagulant apixaban in left ventricular assist devices (DOAC LVAD) study. J Card Fail. 2024;30:819–28. doi: 10.1016/j.cardfail.2023.10.473.

Kirchhof P, Toennis T, Goette A, Camm AJ, Diener HC, Becher N, et al. Anticoagulation with edoxaban in patients with atrial high rate episodes. N Engl J Med. 2023;389:1167–79. doi: 10.1056/NEJMoa2303062.

Zang L, Zhu H, Wang K, Liu Y, Yu F, Zhao W. Not just anticoagulation—new and old applications of heparin. Molecules. 2022;27:6968. doi: 10.3390/molecules27206968.

Thobani A, Dhindsa DS, DeMoss BD, Raad M, Sandesara PB, Sperling LS, et al. Usefulness of aspirin for primary prevention of atherosclerotic cardiovascular disease. Am J Cardiol. 2019;124:1785–9. doi: 10.1016/j.amjcard.2019.08.040.

Raauf AMR, Raauf SS, Abed NK. Non steroidal anti inflammatory drugs (NSAIDs): synthesis of ibuprofen, naproxen and nabumetone. Al Mustansiriyah J Pharm Sci. 2019;19:19–27. doi: 10.32947/ajps.v19i3.570.

Corrigan T, O’Malley L, Bailey D, Moseley H, Okaikoi J, Brown T, et al. Changes in the physical and mechanical properties of human blood with sustained prophylactic use of acetylsalicylic acid (aspirin)—a rheological study. Open J Fluid Dyn. 2021;11:167–76. doi: 10.4236/ojfd.2021.114010.

Badria FA. Drug repurposing: hypothesis, molecular aspects and therapeutic applications. Norderstedt: BoD—Books on Demand; 2020. ISBN 978 1 83968 522 4.

James EI, Murphree TA, Vorauer C, Engen JR, Guttman M. Advances in hydrogen/deuterium exchange mass spectrometry and the pursuit of challenging biological systems. Chem Rev. 2021;122:7562–623. doi: 10.1021/acs.chemrev.1c00279.

Kostyukevich Y, Acter T, Zherebker A, Ahmed A, Kim S, Nikolaev E. Hydrogen/deuterium exchange in mass spectrometry. Mass Spectrom Rev. 2018;37:811–53. doi: 10.1002/mas.21565.

Atzrodt J, Derdau V, Kerr WJ, Reid M. Deuterium and tritium labelled compounds: applications in the life sciences. Angew Chem Int Ed. 2018;57:1758–84. doi: 10.1002/anie.201704146.

Sharhan HI. H/D exchange using metal colloids in synthesis [thesis]. University of Sussex; 2018. Available from: http://sro.sussex.ac.uk/.

Trejo Soto C, Hernández Machado A. Normalization of blood viscosity according to the haematocrit and the shear rate. Micromachines (Basel). 2022;13:357. doi: 10.3390/mi13030357.

Lee CH, Jung KH, Cho DJ, Jeong SK. Effect of warfarin versus aspirin on blood viscosity in cardioembolic stroke with atrial fibrillation: a prospective clinical trial. BMC Neurol. 2019;19:1–7. doi: 10.1186/s12883-019-1315-5.

Al Kinany SQ, Inayah H, Al Kazazz FFM. A novel approach to the synthesis of acetylsalicylic acid via H/D substitution. Pharmakeftiki. 2025;37(2S):99–103. doi: 10.60988/p.v37i2S.152.

Abdulhussein SK, Al Kazazz FFM, Rheima AM. The risk factors in serum of peripheral neuropathy diabetic and type 2 diabetes patients. Iran J War Public Health. 2022;14:133–8. doi: 10.29252/ijwph.14.2.133.

Ebrahimi M, Seyedi SA, Nabipoorashrafi SA, Rabizadeh S, Sarzaeim M, Yadegar A, et al. Lipid accumulation product (LAP) index for the diagnosis of nonalcoholic fatty liver disease (NAFLD): a systematic review and meta analysis. Lipids Health Dis. 2023;22:41. doi: 10.1186/s12944-023-01802-6.

Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. The visceral adiposity index is a predictor of incident nonalcoholic fatty liver disease: a population based longitudinal study. Clin Res Hepatol Gastroenterol. 2020;44:375–83. doi: 10.1016/j.clinre.2019.04.002.

Ikeue K, Kusakabe T, Yamakage H, Ishii K, Satoh Asahara N. A body shape index is useful for BMI independently identifying Japanese patients with obesity at high risk of cardiovascular disease. Nutr Metab Cardiovasc Dis. 2024;34:387–94. doi: 10.1016/j.numecd.2023.09.008.

Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ. Comparison of body mass index, body adiposity index, waist circumference, waist to hip ratio and waist to height ratio as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One. 2015;10:e0122985. doi: 10.1371/journal.pone.0122985.

Zhu K, Hunter M, James A, Lim EM, Cooke BR, Walsh JP. Relationship between visceral adipose tissue and bone mineral density in Australian baby boomers. Osteoporos Int. 2020;31:2439–48. doi: 10.1007/s00198-020-05556-0.

Bae YU, Kim Y, Lee H, Kim H, Jeon JS, Noh H, et al. Bariatric surgery alters microRNA content of circulating exosomes in patients with obesity. Obesity (Silver Spring). 2019;27:264–71. doi: 10.1002/oby.22379.

Luyendyk JP, Schoenecker JG, Flick MJ. The multifaceted role of fibrinogen in tissue injury and inflammation. Blood. 2019;133:511–20. doi: 10.1182/blood-2018-07-818211.

Kattula S, Byrnes JR, Wolberg AS. Fibrinogen and fibrin in hemostasis and thrombosis. Arterioscler Thromb Vasc Biol. 2017;37:e13–e21. doi: 10.1161/ATVBAHA.117.308564.

Zhang T, Chen J, Tang X, Luo Q, Xu D, Yu B. Interaction between adipocytes and high density lipoprotein: new insights into the mechanism of obesity induced dyslipidemia and atherosclerosis. Lipids Health Dis. 2019;18:1–11. doi: 10.1186/s12944-019-1170-9.

Kaur R, Kaur M, Singh J. Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc Diabetol. 2018;17:1–17. doi: 10.1186/s12933-018-0763-3.

Brun JF, Varlet Marie E, Raynaud de Mauverger E, Mercier J. Both overall adiposity and abdominal adiposity increase blood viscosity by separate mechanisms. Clin Hemorheol Microcirc. 2011;48:257–63. doi: 10.3233/CH-2011-1418.

Fossum E, Hoieggen A, Moan A, Nordby G, Velund TL, Kjeldsen SE. Whole blood viscosity, blood pressure and cardiovascular risk factors in healthy blood donors. Blood Press. 1997;6:161–65. doi: 10.3109/08037059709061932.

Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ. Comparison of body mass index, body adiposity index, waist circumference, waist to hip ratio and waist to height ratio as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One. 2015;10:e0122985. doi: 10.1371/journal.pone.0122985.

Gu Z, Li D, He H, Wang J, Hu X, Zhang P, et al. Body mass index, waist circumference, and waist to height ratio for prediction of multiple metabolic risk factors in Chinese elderly population. Sci Rep. 2018;8:1–6. doi: 10.1038/s41598-017-18854-1.

Borruel S, Moltó JF, Alpanes M, Fernandez Duran E, Alvarez Blasco F, Luque Ramirez M, et al. Surrogate markers of visceral adiposity in young adults: waist circumference and body mass index are more accurate than waist hip ratio, model of adipose distribution and visceral adiposity index. PLoS One. 2014;9:e114112. doi: 10.1371/journal.pone.0114112.

Ejtahed HS, Kelishadi R, Qorbani M, Motlagh ME, Hasani Ranjbar S, Angoorani P, et al. Utility of waist circumference to height ratio as a screening tool for generalized and central obesity among Iranian children and adolescents: the CASPIAN V study. Pediatr Diabetes. 2019;20:530–37. doi: 10.1111/pedi.12855.

Lo K, Huang YQ, Shen G, Huang JY, Liu L, Yu YL, et al. Effects of waist to height ratio, waist circumference, body mass index on the risk of chronic diseases, all cause, cardiovascular and cancer mortality. Postgrad Med J. 2021;97:306–11. doi: 10.1136/postgradmedj-2020-137542.

Zhu Y, Huang Y, Sun H, Chen L, Yu H, Shi L, et al. Novel anthropometric indicators of visceral obesity predict the severity of hyperlipidemic acute pancreatitis. Lipids Health Dis. 2024;23:120. doi: 10.1186/s12944-024-02112-1.

Ding YS, Li Y, Zhang XH, Ma RL, Guo H, Ma L, et al. The improved lipid accumulation product is an accurate index for predicting metabolic syndrome in the Xinjiang population. Biomed Environ Sci. 2021;34:503–7. doi: 10.3967/bes2021.070.

Demirbas N, Kutlu R. Importance of measured body fat, visceral adiposity index, and lipid accumulation product index in predicting cardiometabolic risk factors. Metab Syndr Relat Disord. 2021;19:174–79. doi: 10.1089/met.2020.0098.

Başar Gökcen B, Akdevelioğlu Y, Canan S, Bozkurt N. Evaluation of the relationship between serum ferritin and insulin resistance and visceral adiposity index (VAI) in women with polycystic ovary syndrome. Eat Weight Disord. 2021;26:1581–93. doi: 10.1007/s40519-020-00980-x.

Manna P, Jain SK. Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: causes and therapeutic strategies. Metab Syndr Relat Disord. 2015;13:423–44. doi: 10.1089/met.2015.0095.

Kostapanos MS, Florentin M, Elisaf MS, Mikhailidis DP. Hemostatic factors and the metabolic syndrome. Curr Vasc Pharmacol. 2013;11:880–905. doi: 10.2174/15701611113116660171.

Tagoe EA, Santa SA. The role of mitochondrial dysfunction in metabolic syndrome. In: Amponsah SK, Ofori EK, Pathak YV, Eds. Current Trends in the Diagnosis and Management of Metabolic Disorders. CRC Press; 2023. p.60–85. ISBN 9781003384823.

Olubamwo OO. Fatty liver index and risk of incident cardiometabolic disease and mortality [dissertation]. Joensuu (FI): Itä Suomen yliopisto; 2023. ISBN 978 952 61 4798 7.

Vizza P, Tradigo G, Parrilla M, Guzzi PH, Gnasso A, Veltri P. On blood viscosity and its correlation with biological parameters. In: ICCS 2018. Cham: Springer; 2018. p.347–53. doi: 10.1007/978-3-319-93701-4_26.

Joles JA, Willekes Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine. Kidney Int. 1997;52:761–70. doi: 10.1038/ki.1997.393.

Sloop G, Pop GA, St Cyr JA. The haematocrit and blood viscosity are modulated to maintain constant wall shear stress in the carotid sinus. BIOcomplexity. 2024;2024. doi: 10.5048/BIO C.2024.2.

Alkhaldy HY, Awan ZA, Abouzaid AA, Elbahaey HM, Al Amoudi SM, Shehata SF, et al. Effect of altitude on haemoglobin and red blood cell indices in adults in different regions of Saudi Arabia. Int J Gen Med. 2022:3559–65. doi: 10.2147/IJGM.S358139.

Méndez Mora L, Cabello Fusarés M, Ferré Torres J, Riera Llobet C, Krishnevskaya E, Trejo Soto C, et al. Blood rheological characterization of β thalassemia trait and iron deficiency anemia using front microrheometry. Front Physiol. 2021;12:761411. doi: 10.3389/fphys.2021.761411.

Pezzella FR, Antonenko K, Sokolova L. Hyperviscosity syndrome. In: Uluduz D, Arsovska A, Eds. Rare Causes of Stroke: A Handbook. 2022. p.162. ISBN 9781108821254.

Caimi G, Canino B, Lo Presti R, Urso C, Hopps E. Clinical conditions responsible for hyperviscosity and skin ulcers complications. Clin Hemorheol Microcirc. 2017;67:25–34. doi: 10.3233/CH-160218.

Vogel J, Kiessling I, Heinicke K, Stallmach T, Ossent P, Vogel O, et al. Transgenic mice overexpressing erythropoietin adapt to excessive erythrocytosis by regulating blood viscosity. Blood. 2003;102:2278–84. doi: 10.1182/blood-2003-01-0283.

Roshal M, Gil MR. Prothrombin time. In: Shaz BH, Hillyer CD, Gil MR, Eds. Transfusion Medicine and Hemostasis. Elsevier; 2019. p.773–77. doi: 10.1016/B978-0-12-813726-0.00128-8.

Zaidi SRH, Rout P. Interpretation of blood clotting studies and values (PT, PTT, aPTT, INR, anti factor Xa, D dimer). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: NBK60421.

Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. High triglyceride/HDL cholesterol ratio is associated with silent brain infarcts in a healthy population. BMC Neurol. 2019;19:1–8. doi: 10.1186/s12883-019-1373-8.

Almarshad HA, Hassan FM. Alterations in blood coagulation and viscosity among young male cigarette smokers of Al Jouf region in Saudi Arabia. Clin Appl Thromb Hemost. 2016;22:386–9. doi: 10.1177/1076029614561319.

Belete TM. Recent updates on the development of deuterium containing drugs for the treatment of cancer. Drug Des Devel Ther. 2022;3465–72. doi: 10.2147/DDDT.S379496.

Qureshi MH. Expansion of the anionic amino Cope cascade and deuteration of monomers for the creation of perdeuterated polymers [dissertation]. Tucson (AZ): University of Arizona; 2022. Available from: http://hdl.handle.net/10150/667258.

Bruno A, Tacconelli S, Contursi A, Ballerini P, Patrignani P. Cyclooxygenases and platelet functions. In: Advances in Pharmacology. Academic Press; 2023. p.133–65. doi: 10.1016/bs.apha.2022.12.001.

Jia YM, Gu TT, Ji JZ, Tai T, Zhang MR, Huang BB, et al. Aspirin attenuates the bioactivation of and platelet response to vicagrel in mice. J Cardiovasc Pharmacol. 2018;72:252–58. doi: 10.1097/FJC.0000000000000622.

Published
2026/04/29
Section
Original article