There are many misconceptions about the application of aspirin, and the clinical application of aspirin is chaotic and unhelpful. So, how should aspirin be used? Aspirin is not without side effects, and can cause gastrointestinal bleeding and cerebral hemorrhage, and its indiscriminate use can be harmful. Who must use it? People who have had an angiogram to confirm a diagnosis of coronary artery disease, myocardial infarction, stroke, peripheral vascular disease, stenting or heart bypass surgery, and who have been diagnosed with cardiovascular disease, should take aspirin if it is not contraindicated. It is important to emphasize that coronary heart disease is diagnosed by a cardiovascular specialist, not because of an electrocardiogram or premature beats or atrial fibrillation. Do all people over 40 years old need to take it? There is a misconception that everyone over the age of 45 takes aspirin to prevent heart disease. Studies have found that daily aspirin does not reduce deaths in people without cardiovascular disease, with a net benefit of only 5 fewer myocardial infarctions per 10,000 people per year, but 3 more severe bleeds. The recommendations of guidelines in different countries and regions are also inconsistent. Our expert consensus on the standardized use of aspirin recommends aspirin for the prevention of cardiovascular disease in the following cases: (1) Those who have hypertension but whose blood pressure is controlled below 150/90 mmHg and who also have one of the following conditions can apply aspirin for primary prevention: (1) age 50 years or older; (2) have target organ damage, including moderate increase in plasma creatinine; (3) diabetes. (2) Patients over 40 years of age with type 2 diabetes combined with the following cardiovascular risk factors: ① Family history of early onset coronary heart disease (immediate family history of onset in men < 55 years of age and women < 65 years of age). ②Smoking. (iii) Hypertension. ④Overweight and obesity, especially abdominal obesity. ⑤ Albuminuria. (6) Dyslipidemia. (3) People with 10-year risk of ischemic cardiovascular disease/>10% or a combination of three or more of the following risk factors: ① Dyslipidemia. ②Smoking. (3) Obesity. ④>50 years of age. ⑤ Family history of early onset cardiovascular disease. Risk and benefit assessment is required to determine the need for aspirin. Bedside lifesaving triplet, really so amazing? It is rumored on the internet that aspirin is one of the three lifesavers at the bedside, and all people who suspect a heart attack need to take aspirin immediately to save their lives. Is it really that amazing? During a myocardial infarction, aspirin can quickly inhibit platelet aggregation and has a role in slowing down the progression of the disease. For emergency treatment of myocardial infarction, taking aspirin can reduce the mortality rate by 20-30%. European guidelines for chest pain recommend that patients with suspected myocardial infarction should immediately call for emergency care while taking aspirin. However, lay people lack the knowledge to identify heart disease, and taking aspirin in case of digestive tract disease or aortic coarctation is harmful instead. It is recommended to call emergency first when a heart attack is suspected, and take the medication under the guidance of emergency professionals. In case of emergency, the dose should not be too small, but should be 300mg, and should be chewed up so that it can be absorbed quickly and take effect as soon as possible. How long do I need to take it? All patients who meet the indications for taking aspirin and have no side effects such as gastrointestinal bleeding or asthma attack during taking, need to take it for a long time as long as they can tolerate it. Should I take enteric tablets on an empty stomach or after a meal? Previously, aspirin reached the stomach and disintegrated under the action of acidic gastric juice, causing gastrointestinal irritation and even bleeding from gastric mucosal damage, which is a common side effect of aspirin, and taking it after meals can reduce the side effects. At present, enteric aspirin is coated with an acid-resistant coating to protect it from being dissolved in the acidic environment of the stomach and slowly released and absorbed in the alkaline environment of the small intestine to reduce adverse gastrointestinal reactions. If taken during or after a meal, aspirin will mix with alkaline substances in food to prolong the residence time in the stomach and release the aspirin drug will produce gastrointestinal side effects. It is recommended to take aspirin enteric tablets on an empty stomach to shorten the residence time in the stomach and reach the absorption site in the small intestine smoothly. Should I take it in the morning or in the evening? There is no definite controversy on this issue, and there are different opinions on whether to take the drug in the evening or in the morning. Some people believe that taking aspirin at night is more effective based on the fact that platelets are more active between 2:00 p.m. and 10:00 a.m., which is also the time when cardiovascular disease is more prevalent. Some studies have also found that taking it in the morning with higher blood levels of prostacyclin at night is more effective in preventing nighttime cardiovascular attacks, suggesting that it should be taken in the morning. In fact, it does not matter what time of day you take the drug, as long as you take aspirin consistently for a long period of time you will get a sustained platelet inhibitory effect. In terms of efficacy, the current consensus among experts is that the effect of long-term aspirin use is continuous, and there is little difference between morning and evening, the key is persistence. However, when aspirin is taken before bedtime, the food in the stomach is not emptied and the aspirin mixes with food, prolonging the retention time in the stomach and leading to gastrointestinal adverse reactions. The drug usually stays in the stomach for about 1 hour. Taking aspirin 1 hour before a morning fasting meal will not affect the retention time of aspirin in the stomach and reduce the gastrointestinal side effects. It is recommended to take aspirin 1 hour before meal in the morning on an empty stomach; if you have gastrointestinal adverse reactions when taking the drug in the morning on an empty stomach, try to take the drug at night before bedtime. What is the optimal dose? The optimal dose of aspirin is 75-150 mg. It is often encountered in clinical practice that some people worry about the side effects and take one or two aspirin enteric tablets (25 mg/tablet), which cannot achieve therapeutic and preventive effects. More than 150 mg cannot increase the efficacy, but only increase the side effects. Currently, imported aspirin at 100 mg per tablet is enough for one tablet a day, and domestic 25 mg aspirin for 3 or 4 tablets (taken in one dose). Who is prone to gastrointestinal bleeding after taking it? Aspirin is a double-edged sword. Aspirin can act directly on the gastric mucosa, destroying the protective barrier of the gastric mucosa, promoting the release of leukotrienes and other cytotoxic substances, and damaging the gastric mucosa; it can also damage the intestinal mucosal barrier. The inhibition of cyclooxygenase after absorption into the blood leads to a decrease in the synthesis of prostaglandins that have a protective effect on the gastric mucosa, leading to damage and irritation of the gastrointestinal tract, which can cause serious gastrointestinal bleeding. People with the following conditions are more likely to develop gastrointestinal damage and bleeding and should pay more attention to them: elderly people over 65 years old, history of peptic ulcer or bleeding, H. pylori infection, smoking and alcohol consumption, taking non-steroidal painkillers or glucocorticoids, combination of multiple antiplatelet or anticoagulant drugs, combination of spironolactone or antidepressants. Early consultation should be made once progressive anemia or dark stools are detected. Long-term aspirin consumption is best to check stool occult blood every 3 months at the hospital to detect bleeding early. How should patients who have had stents take it? Patients who have had a stent for coronary artery disease are often seen to stop taking aspirin and take clopidogrel after taking dual antiplatelet drugs for 12 months. This is incorrect. Current studies have confirmed that clopidogrel is not a substitute for aspirin for secondary prevention. The correct approach is to take aspirin and clopidogrel in a double combination of antiplatelet agents.