Q: What are the effects of different doses of aspirin? A: Different doses of aspirin can achieve different effects: small doses of aspirin (75-300 mg/d) have anti-platelet effects; medium doses of aspirin (500 mg/d-3 g/d) have antipyretic and analgesic effects; large doses of aspirin (more than 4 g/d) have anti-inflammatory and anti-rheumatic effects. The dose of aspirin required to inhibit platelet aggregation is much smaller than that required for pain relief and antirheumatism. Because high doses increase the inhibition of prostacyclin synthesis, low-dose aspirin should theoretically be used in preference. An analysis completed by the Antithrombotic Trials Collaborative Group in 2002 confirmed that long-term antiplatelet therapy with low-dose aspirin (75-150 mg/d) is effective, but in acute situations, a loading dose of at least 150 mg of the first dose may be required. Q: How to choose the timing, dosing interval and dosage form of aspirin scientifically? A: Enteric aspirin should ideally be taken after breakfast to increase patient compliance and tolerability. In clinical practice, intervals of more than 2 days are not recommended. The benefits of taking small doses of aspirin frequently are increased tolerability and reduced prostacyclin inhibition by aspirin. To reduce the adverse effects of aspirin, enteric aspirin should be administered on a long-term basis. For certain emergency cases (e.g., heart attack), physicians recommend the use of water-soluble aspirin or taking enteric aspirin tablets by mouth or chewing. Q: How can adverse reactions to aspirin therapy be reduced? A: The most common adverse reaction to aspirin is damage to the gastric mucosa, which in some cases can cause bleeding, associated with increased doses. High doses of aspirin double the risk of gastrointestinal bleeding, but fatal bleeding is relatively uncommon. Caution should be exercised especially in patients with a bleeding tendency or the presence of gastrointestinal disease, especially when aspirin is combined with other drugs that alter blood rheology (e.g., anticoagulants). Lowering the dose of aspirin does not necessarily reduce the frequency of bleeding, but it does reduce the severity of the bleeding that occurs. Ways to improve tolerability include: applying small doses (75-150 mg) of aspirin; preferably taking enteric solvent form; removing H. pylori along with gastric mucosal protection; and measuring the patient’s platelets as well as other laboratory parameters. Q: Do I need to stop taking aspirin before surgery? A: In the past, it was considered that the drug should be stopped for more than 10 days prior to surgery. Today, there is a different answer to this question: it is necessary to consider the benefits and risks for each individual. For example, elderly people with heart disease are not advised to stop taking their medication at the time of surgery. The risk of bleeding from minor surgery such as prostatectomy, oral surgery or superficial skin surgery is lower than the risk of a cardiovascular event without aspirin. Even when coronary artery bypass surgery was performed while aspirin was continued, no other complications occurred. Clinical experience suggests that discontinuing aspirin 48 hours prior to surgery is sufficient. Q: Does gender have an effect on the antiplatelet effect of aspirin? A: Overall, there are no significant gender differences. To date, no gender differences in aspirin pharmacokinetics have been reported in the literature. Previous studies have suspected that aspirin is less protective in women than in men, and some recent studies have failed to prove this idea. Q: Is there an increased risk of thrombosis after discontinuation of aspirin (rebound after discontinuation)? A: There is no evidence to support an increased risk of thrombosis after discontinuation of aspirin. If the body increases thromboxane receptors on platelets at the same time that aspirin inhibits thromboxane synthesis (a phenomenon called upregulation), then the risk of thrombosis increases after discontinuation of aspirin. Study data show that the type and number of platelet thromboxane receptors do not change after 2 weeks of aspirin application in healthy individuals. Q: With which substances does aspirin interact and thus affect the antiplatelet effect? A: Anticoagulants: Concomitant administration of anticoagulants can increase the antiplatelet effect of aspirin; therefore, the combination of the two is limited to patients with specific risk factors. ACEI: Different results have been reported in the literature regarding the interaction between aspirin and ACE inhibitors, and therefore no conclusions can be drawn. Alcohol: Alcohol consumption in healthy individuals increases the antiplatelet and prolonged bleeding time effects of aspirin. Acid suppressants/milk: Concomitant administration of acid suppressants or milk does not affect the rate of aspirin absorption. Q: What are some medications that can be used as a prophylactic alternative to aspirin? A: In addition to aspirin, ticlopidine and clopidogrel are frequently used platelet aggregation inhibitors. When treatment with aspirin is contraindicated, clopidogrel can be used as a substitute for aspirin. However, the cost of treatment is increased. Q: Can antithrombotics be combined with aspirin? A: Ticlopidine, clopidogrel and glycoprotein IIb/IIIa receptor antagonists have different mechanisms of action than aspirin and may have complementary effects when combined in certain diseases. The above combinations may prolong the bleeding time and increase the risk of adverse effects. The clinical system, especially the cardiovascular system, now attaches importance to the anticoagulant role of aspirin, so we have collected some information to see, there are other better hope to follow the post Q: What measures should be taken for “treatment resistance”? A: A patient is considered “treatment resistant” if he or she does not respond to the conventional recommended treatment regimen (e.g., application of standard doses). The term “treatment resistance” here does not include treatment failure due to diagnostic errors. In this case, the patient should first be examined for indications for aspirin. For example, 70% of patients with carotid artery stenosis require surgical intervention. In patients with cardiac vascular embolism, anticoagulants provide more effective protection. If these factors are ruled out, a change in dosing should be considered to individualize the dose. Intermittent administration of high doses (e.g., 500 mg aspirin every 14 days) in patients with a rapid platelet renewal rate may improve outcomes. Or consider a change in dosing strategy, such as switching to nighttime dosing. Laboratory tests (e.g., bleeding time) may be used to see if the drug is working. If it is still not effective, treatment may be changed to clopidogrel.