1.Is aspirin taken before or after a meal? The traditional use of aspirin in general is to take it after meals, aiming to reduce the direct damage to the gastrointestinal mucosa through the buffering of food. However, enteric aspirin is acid-resistant but not alkali-resistant, so if it is taken after a meal, it does not reflect the advantages of enteric tablets. This is because the buffering of food after a meal dilutes the acidic environment in the stomach and increases the pH of gastric juice, which makes the enteric coating easy to dissolve; in addition, the mixing of tablets and food prolongs the stagnation time of the drug in the stomach, which also makes it easy to destroy the enteric coating. When taken before meals, the acidic environment in the stomach is strong in fasting, the enteric coating is not easy to dissolve and the gastric emptying speed is fast, so the residence time in the stomach is short, which can reduce the damage of the drug to the gastric mucosa. Observational studies also confirmed that: taking enteric aspirin before meals can significantly reduce the incidence of gastrointestinal adverse reactions, and for patients with epigastric pain, burning sensation and other discomfort symptoms after taking aspirin enteric tablets after meals, most of the patients no longer have gastrointestinal discomfort symptoms after taking the drug 20-30 min before meals instead. Therefore, for aspirin enteric tablets are recommended to be taken before meals to reduce damage to the gastric mucosa. 2.Should enteric tablets be given “not chewed”? The most common method for aspirin enteric tablets is to take 100mg per day by mouth with appropriate amount of water before meals. Since aspirin enteric tablets are acid-resistant, they do not dissolve in acidic gastric juices but dissolve in alkaline intestinal juices. The absorption of aspirin enteric tablets is delayed by 3-6 hours compared to regular tablets. When a patient presents with suspected acute myocardial infarction onset: an initial dose of 300 mg, chewed, is recommended for rapid absorption (not limited to enteric aspirin). Therefore, in general, it is not necessary to deliver “not to chew and take” to avoid misunderstanding by patients and delaying self-help at the onset of acute myocardial infarction. 3. Is there still a risk of gastrointestinal bleeding when taken before meals? High-quality aspirin enteric coating dissolves only in the alkaline environment in the duodenum, thus avoiding direct damage to the gastric mucosa. However, it does not significantly reduce the risk of gastrointestinal bleeding. Among the mechanisms of aspirin-induced gastrointestinal bleeding, in addition to its direct damaging effect on the gastrointestinal mucosa, aspirin inhibits cyclooxygenase (COX) activity, reduces the synthesis of prostaglandins, a protective factor of the gastrointestinal mucosa, decreases the synthesis of thromboxane A2, and reduces the aggregation ability of platelets, which predispose to bleeding. Gastrointestinal adverse reactions caused by aspirin range from mild dyspepsia to fatal peptic ulcer bleeding and perforation. Studies have shown that aspirin can increase the risk of GI injury by 2-4 times. The absolute risk of serious GI bleeding from aspirin is 0.12% per year. The above content is transferred from “Clinical Use” WeChat platform. Combined with clinical application, we believe that taking aspirin on an empty stomach can shorten the residence time in the stomach and reach the absorption site in the small intestine smoothly, so it is recommended that aspirin enteric-coated tablets should be taken preferably on an empty stomach. However, the prerequisite is to use enteric-coated enteric aspirin tablets, which are more advantageous to import. We recommend individualized medication under the guidance of a doctor, and prohibit unauthorized use of drugs!