Antiplatelet treatment with aspirin could be a new treatment option for vasculogenic erectile dysfunction (VED), particularly for men with a high mean platelet volume (MPV), according to investigators.
In a prospective randomized double-blind placebo-controlled study, Zeki Bayraktar, MD, and Selami Albayrak, MD, of Istanbul Medipol University in Turkey, found that therapy with 100 mg/day of aspirin for 6 weeks was associated with significant improvement in erectile function compared with placebo among men with VED and a high MPV.
“Large platelets are metabolically and enzymatically more active than small platelets and produce more thromboxane, known as the most potent vasoconstrictor agent,” the investigators explained.
Some recently published studies have found a relationship between high MPV values and VED, but no previous study has examined the efficacy of antiplatelet therapy on VED, they noted.
The investigators evaluated erectile function using the International Index of Erectile Function (IIEF-EF) and 2 yes-or-no questions on the Sexual Encounter Profile (SEP) instrument: SEP2 (“Were you able to insert your penis into partner’s vagina?”) and SEP3 (Did your erection last long enough for you to have successful intercourse”?).
The aspirin and placebo groups included 120 and 64 patients, respectively, with mean ages of 48.3 and 47.7 years. To be included in the study, patients needed to have an MVP above 11 fL. According to the assay kits used to measure MVP, the normal range for MPV is 7.8 to 11 fL, the authors noted. The aspirin and placebo groups had similar mean MVP values (11.57 and 11.54 fL respectively).
The mean baseline IIEF-EF scores in the aspirin and placebo groups were similar (14.1 and 14.3, respectively). At the end of treatment, the mean IIEF-EF score was 21.3 in the aspirin group (a 7.2-point increase) compared with 16.3 among placebo recipients (a 2-point increase), a significant difference between the groups, Drs Bayraktar and Albayrak reported online in International Urology and Nephrology.
At baseline, the proportions of patients who answered yes to SEP2 and SEP3 were similar in both study arms: 51.6% and 31.6%, respectively, for the aspirin group and 50% and 31.2% for the placebo group. At the end of treatment, the proportions answering yes to SEP2 and SEP3 were significantly higher in the aspirin than placebo group (88.3% and 78.3% vs 59.3% and 43.5%).
“Aspirin is an effective and safe therapeutic option for patients with VED, especially for patients with a high MPV,” the authors concluded.
Darshan P. Patel, MD, of the Division of Urology at the University of Utah School of Medicine in Salt Lake City, who was not involved in the new study, said the results of the investigation by Drs Bayraktar and Albayrak should be interpreted with caution. “The study excluded many patients at the highest risk of vasculogenic ED—patients with diabetes, hypertension, coronary artery disease,” said Dr Patel, who participated in a study showing no association between use of nonsteroidal anti-inflammatory drugs and ED among patients in the Prostate Cancer Prevention Trial (BJU Int. 2016;117;500-506). “The unequal allocation (2:1 randomization) harbors certain threats to the internal validity of a confirmatory study. Although the study adds to the growing body of evidence linking endothelial dysfunction to ED, the results must be reproduced prior to drawing conclusions regarding aspirin therapy for prevention and treatment of ED.”
Bayraktar Z, Albayrak S. Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction: a prospective randomized double-blind placebo-controlled study. Int Urol Nephrol. 2018 Jan 17. doi: 10.1007/s11255-018-1786-0