I. Selection
Different doses, different effects
Many readers are concerned about the effect of different doses and dosage forms of aspirin on diseases and whether there is any difference in the use of aspirin between different genders.
1. Q: What are the differences in the effects of different doses of aspirin? What kind of diseases are they used to treat?
Small doses of aspirin (75-300 mg/day) have antiplatelet effects and are often used to prevent thrombosis in coronary and cerebrovascular thrombotic lesions (e.g. myocardial infarction and ischemic stroke) and after other procedures (coronary and peripheral vascular interventions, radiofrequency ablation of cardiac arrhythmias, etc.).
Moderate doses of aspirin (more than 4 g/day) have anti-inflammatory and anti-rheumatic effects and are commonly used in the treatment of acute rheumatic fever, rheumatoid arthritis and rheumatoid arthritis.
2.Q: There are various dosage forms of aspirin such as regular aspirin, bye aspirin, aspirin effervescent tablets and aspirin enteric-coated tablets, what are the differences in their effects? Which one is safe, effective and economical to use?
There is no difference in the effects of these aspirins, only the dosage forms. Compared with ordinary aspirin tablets, aspirin enteric soluble tablets (including BAY aspirin), aspirin enteric soluble particles, and aspirin cytotec tablets can reduce the irritation to the gastrointestinal tract by different release dissolution, but relatively speaking, the price of aspirin in these dosage forms is higher.
3. Q: Does gender have an effect on the anti-platelet effect of aspirin?
Overall, there is no significant difference. There are also studies confirming that women taking aspirin for stroke prevention are not ineffective, but very effective.
Second, the use of the article
Different diseases, different treatments
The role of aspirin in the prevention of cardiovascular accidents has been recognized by many experts, however, the use of different cardiovascular diseases differs in usage.
4.Q: Who needs to take small doses of aspirin for one prevention?
Our experts recommend that the following high-risk groups should take aspirin (optimal dose 75-100 mg/day) for primary prevention.
Patients with hypertension Blood pressure <150/90 mmHg who also have one of the following: age ≥50 years with concomitant target organ damage, including moderately elevated plasma creatinine, diabetes mellitus.
Patients with diabetes who also have one of the following: family history of early-onset coronary heart disease (men <55 years, women <65 years, smoking, hypertension, overweight & obesity, proteinuria, dyslipidemia.
Combination of multiple risk factors (≥3) Dyslipidemia smoking, obesity, age ≥50 years, family history of early-onset cardiovascular disease (men <55 years, women <65 years), lack of exercise.
5.Q: What is the optimal dose of aspirin in secondary prevention?
Secondary prevention refers to the prevention of stroke recurrence with aspirin, and the optimal dose is 75~150 mg/day.
6.Q: What can be used instead of aspirin as preventive medication?
Ticlopidine and clopidogrel can be used as substitute medications. When treatment of thrombosis with aspirin is contraindicated, clopidogrel can be substituted, but it will increase the cost of treatment.
7.Q: Do patients with cardiogenic stroke need aspirin and how to use it?
For patients with cardiogenic stroke (stroke caused by heart disease) with atrial fibrillation, long-term oral anticoagulant therapy, such as warfarin, is recommended. Aspirin is recommended for patients who have contraindications to anticoagulant use or who cannot routinely undergo INR (International Normalized Ratio, which is the standardized prothrombin time) tests.
8. Q: How should aspirin be used in patients with non-cardiogenic stroke and transient cerebral ischemia (TIA)?
For such patients, aspirin 75-300 mg/day is recommended. A combination of aspirin and dipyridamole or clopidogrel (75 mg/day) can also be used.
9. Q: How to use aspirin in patients with ischemic stroke?
Patients with acute ischemic stroke without thrombolytic therapy should use aspirin at a dose of 100-300 mg/day; patients with acute ischemic stroke treated with thrombolytic therapy should use aspirin at a dose of 100-300 mg/day 24 hours after thrombolytic therapy.
Unless there is a contraindication to the use of aspirin, other antiplatelet drugs should not be used in place of aspirin.
10.Q: Which conditions of ischemic heart disease can be treated with aspirin alone? What drugs should be used instead for those who cannot tolerate it?
(1) In chronic stable angina: oral aspirin 75~150 mg/day is recommended for long-term application.
(2) Previous history of myocardial infarction (ECG showing ST-segment elevation and non-elevation): oral aspirin 75-150 mg/day for long-term application is recommended.
(3) Proposed coronary artery bypass grafting: It is recommended that aspirin need not be discontinued before surgery and that oral aspirin 75~150 mg/day be started 24 hours after surgery for long-term application.
(4) Patients with peripheral vascular disease and chronic limb ischemia: long-term aspirin 75~150 mg/day is recommended regardless of whether they receive interventional treatment or not, and patients with carotid stenosis regardless of whether they receive carotid endarterectomy or not.
(5) Patients with coronary artery disease combined with diabetes mellitus: aspirin 75~150 mg/day is recommended.
(6) Atrial fibrillation: 300 mg/day of aspirin is recommended for low- to intermediate-risk patients with non-valvular heart disease atrial fibrillation or high-risk patients for whom warfarin is contraindicated.
(7) After valve replacement: Warfarin should be applied to all those with mechanical valve replacement, and the recommended INR target value is: 2.5 (2.0~3.0). For the combination of other risk factors, such as atrial fibrillation, myocardial infarction, left atrial enlargement, and reduced ejection fraction, it is recommended to combine with aspirin 75~100 mg/day at the same time. When warfarin must be discontinued in patients with valve replacement, treatment with low molecular weight heparin and aspirin 75-100 mg/day is recommended. Because there may be an increased risk of bleeding when warfarin and aspirin are combined, it is recommended that INR values need to be monitored for at least 2 days and then warfarin dosage adjusted according to INR values.
For those who are intolerant or allergic to aspirin, clopidogrel 75 mg/day is recommended as an alternative treatment.
11. Q: According to the US report, 68% of stroke patients taking low-dose aspirin still had high blood viscosity and 47% developed drug resistance. So, how to master the dosage of aspirin for patients who still have high blood viscosity in order to be both effective and safe?
High blood viscosity should be examined to determine the cause of the disease, such as whether blood glucose is elevated or lipid abnormalities are present, and treatment should be given accordingly, not just aspirin. If aspirin is resistant, consider adding or applying one of the following antiplatelet drugs alone.
(1) Ticlopidine (also known as Ralliadex), 150-250 mg once or twice a day, with dosing adjusted according to the condition.
(2) platelet glycoprotein (fibrinogen receptor) antagonists, such as tirofibric acid, have shown good prospects for temporary application.
Third, the use of different, the efficacy varies
12, Q: There is a saying that aspirin is taken halfway through a meal to give full play to its efficacy and minimize its side effects, is this statement correct?
Although, aspirin and food taken together or with water can reduce the stimulation of the gastrointestinal tract, but food can reduce the absorption rate of the drug, and this will not reduce the side effects of bleeding due to its anti-platelet aggregation effect.
13.Q: Is it correct to take aspirin at night?
It is best to take it after the noon meal. However, if there is a risk of myocardial infarction or thrombosis, consider taking it at night before bedtime. There is no difference in the time to take aspirin for different diseases.
Combined medication, must be careful
14.Q: Can aspirin not be combined with vitamin B1?
The scientific formulation is “aspirin should not be taken with vitamin B1 at the same time”. Because vitamin B1 can increase the acidity of the gastric juice and aggravate the damage of aspirin to the gastric mucosa. However, the effect of vitamin B1 to increase the acidity of gastric juice does not last long, as long as the time of the drug is staggered by more than one hour, the two can be used together.
15.Q: Which drugs can’t aspirin be combined with?
Combining aspirin with other NSAIDs (such as oral Fotarine, Fenbendazole, etc.), anticoagulants (warfarin) and glucocorticoids can increase the risk of bleeding, especially gastrointestinal bleeding, and should be avoided as much as possible. Combination with insulin or oral hypoglycemic drugs can enhance their blood-lowering effect, and care should be taken to avoid the occurrence of hypoglycemia.
16.Q: Is it safe to use heparin drugs in combination with aspirin?
If it is necessary to use drugs such as heparin to prevent deep vein thrombosis and other special cases, it is safe to use aspirin in combination.
17.Q: How to combine aspirin with other anti-platelet drugs?
Generally, it is selected in 3 cases.
(1) Acute myocardial infarction with ST-segment elevation
The combination of aspirin plus clopidogrel is recommended regardless of whether PCI (percutaneous transluminal coronary catheter intervention) is received. The initial dose of aspirin is 150-300 mg/day, which is changed to 75-150 mg/day after 1-7 days for long-term application. Clopidogrel 300 mg, changed to 75 mg/day the next day. For patients without interventional therapy, clopidogrel should be taken for at least 1 month; for patients undergoing interventional therapy, clopidogrel 75 mg/day is recommended and continued for 9 to 12 months.
For those who are intolerant or allergic to aspirin, clopidogrel may be used as an alternative treatment (75 mg/day).
(2) Non-ST-segment elevation acute myocardial infarction (AMI)
Aspirin and clopidogrel should be used in combination, regardless of whether intervention is performed. Initial dose of aspirin 150-300 mg/day once daily; after 1-7 days, change to 50-150 mg/day for long-term application. Clopidogrel 300 mg/day, changed to 75 mg/day the next day, recommended for 9~12 months.
(3) Elective PCI (percutaneous transluminal coronary catheter intervention)
It is recommended to take aspirin orally 100~300 mg/day for 2~3 days; if stent placement is proposed, add clopidogrel 300 mg 6~24 hours before the procedure; after the procedure, aspirin 100~300 mg/day and continue to take it for a long time; also add clopidogrel 75 mg/day for at least 1 month for bare metal stent placement, and for at least 6 months for drug-eluting stent placement.
IV. Safety
Safety first, understand the use
18. Q: Can I get addicted to aspirin if I take it regularly? If so, how to overcome it?
Aspirin is generally not addictive when taken in small doses for a long time. When aspirin is taken in large doses for pain relief, addiction may occur. In this case, it can be combined with other painkillers (such as codeine) to enhance the pain relief effect on the one hand and reduce the dosage of each on the other hand; if addiction has already occurred, you can switch to other painkillers.
19.Q: Will the risk of blood clots increase after stopping aspirin?
There is no evidence to prove that the risk of aspirin thrombosis increases when aspirin is discontinued.
20.Q: What is safe and effective for patients with both hypertension and rheumatoid arthritis, who need to take small doses of aspirin for a long time to prevent stroke and high doses of anti-inflammatory analgesia?
For these patients using high-dose anti-inflammatory analgesics, if they do have risk factors for both stroke or heart disease, they should not stop taking low-dose aspirin even if the combination of these two drugs increases the risk of upper gastrointestinal bleeding. However, when choosing an anti-inflammatory analgesic, a COX-2 inhibitor, such as vanillo, may be preferred. Meanwhile, H2 receptor inhibition such as cimetidine, misoprostol or thioglycollate are applied to protect the gastric mucosa and reduce gastric mucosal damage.
21.Q: Do I need to stop taking aspirin before surgery?
In the past, it was thought that the drug should be stopped for more than 10 days before surgery. Nowadays, it is considered that whether to stop the medication or not depends on the specific situation of each individual and evaluating the risks associated with discontinuing aspirin. For example, discontinuation is not usually recommended for older adults with coronary artery disease at the time of surgery; patients taking aspirin who are facing minor surgery such as prostatectomy, oral surgery, or superficial skin surgery need to choose whether to discontinue aspirin based on the patient’s specific situation (e.g., whether they have a bleeding tendency). This is because the risk of intraoperative and postoperative bleeding is minimal in patients without bleeding tendency, even if aspirin is continued intraoperatively, whereas the risk of cardiovascular events is much higher when aspirin is discontinued; no other complications have been observed with continued aspirin use when coronary artery bypass grafting is performed. Therefore, it is usually sufficient to discontinue aspirin 48 hours before the procedure.
22.Q: What are the adverse effects of aspirin? May it cause hepatomegaly?
The most common adverse reaction is damage to the gastric mucosa, causing gastric or duodenal ulcers or gastrointestinal bleeding. High doses of aspirin can increase the risk of gastrointestinal bleeding. Therefore, it should be used with caution in patients with gastric and duodenal ulcers and chronic gastritis. There is no information that aspirin can cause hepatomegaly.
23.Q: Are aspirin enteric tablets still irritating to the stomach? Is there any risk of gastric bleeding in patients with hypertension and duodenal ulcer who take aspirin soluble tablets?
Aspirin causes gastrointestinal side effects, including ulcers, bleeding and even perforation, through two main mechanisms. First, direct irritation and damage to the mucosa of the gastrointestinal tract by aspirin; second, related to the pharmacological mechanism of aspirin, aspirin inhibits platelet aggregation, which makes it difficult to stop bleeding once there is a small amount of bleeding, and also reduces the production of substances in the body that can protect the gastric mucosa, which leads to damage to the gastric mucosa, and the latter is more important in both of these effects. Therefore, although aspirin enteric tablets do not have a direct stimulating effect on the gastric mucosa, but still can lead to gastric mucosal damage, ulcer patients taking still need to pay attention to the adverse reactions of gastrointestinal bleeding, and, in the ulcer active period, any dose of aspirin is prohibited.
24.Q: How to avoid adverse reactions?
Patients with bleeding tendency or the presence of gastrointestinal diseases should be cautious, especially if they are taking aspirin along with other drugs, such as anticoagulants and blood-activating herbs. The currently recognized methods that can reduce the adverse effects of aspirin are.
①applying small doses (75-150 mg) and reducing the dose of aspirin can reduce the severity of the occurrence of bleeding, although not necessarily the number of bleeding.
(ii) Preferably taking enterolysis form.
(iii) Removal of H. pylori and concomitant administration of gastric mucosal protective agents, such as thioglycollate and Metzolim-S granules.
④Monitor the patient’s platelets as well as bleeding and clotting time.
25.Q: Ning reader in Shanxi Province said that he takes 100 mg of aspirin every day and feels that the stomach acid is aggravated after taking it, so he takes 5~10 grams of soda powder again, I wonder if this practice is correct?
This practice is not correct, because soda is alkaline, it will reduce the effectiveness of aspirin after neutralizing stomach acid, so this method is not recommended. The correct approach is to take gastric mucosal protective drugs, such as aluminum thioglycollate and Metzolim-S granules before meals, and then take aspirin after meals to reduce gastrointestinal symptoms.