Indications for the application of aspirin antiplatelet therapy
Definitely beneficial for.
1.Acute myocardial infarction.
2, Secondary prevention after myocardial infarction.
3.Angina pectoris.
4.Coronary revascularization (bypass, stent, PTCA).
5.Transient ischemic attack (TIA), reversible ischemic brain disease (PRIND) and post-stroke secondary prevention.
6. Arteriovenous shunts in dialysis patients.
Indications for the application of aspirin antiplatelet therapy
May be beneficial for.
1. Primary prevention of coronary heart disease.
2. Immediate post-stroke treatment.
3. Atrial fibrillation.
4. Peripheral arterial occlusive disease.
5.Deep vein thrombosis.
6.Prevention of emboli after prosthetic valve replacement.
Different effects of different doses of aspirin
Small dose aspirin (75-300mg/d) has anti-platelet effect.
Medium dose aspirin (500mg-3g/d) has antipyretic and analgesic effect.
High dose aspirin (more than 4g/d) has anti-inflammatory and anti-rheumatic effects.
How to choose the dosing time, dosing interval and dosage form of aspirin scientifically
Dosing time: Enteric aspirin should preferably be taken after breakfast to increase patient compliance and tolerability.
Dosing interval: In clinical practice, an interval of more than 2 days is not recommended. The benefit of frequent dosing is to increase tolerability while reducing its inhibition of prostacyclin.
Dosage form: To reduce the adverse effects of aspirin, enteric aspirin should be taken long-term. For certain acute conditions such as heart attack, aspirin may be used in water or enteric aspirin may be dissolved or chewed.
How to reduce the adverse effects of aspirin therapy
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 less common. 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 enterolytic form; removing H. pylori and taking gastric mucosal protection; and measuring the patient’s platelets and other laboratory parameters.
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. Today, there is a different answer to this question: it is necessary to consider the benefits and risks for each individual. For example, in elderly people with heart disease, it is not recommended to stop the 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. No other complications have occurred even when coronary artery bypass grafting was performed while aspirin was continued. Clinical experience suggests that discontinuing aspirin 48 hours prior to surgery is sufficient.
Does gender have an effect on the antiplatelet effect of aspirin?
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 demonstrate this.
Is there an increased risk of thrombosis after discontinuation of aspirin (rebound after discontinuation)?
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.
What are the substances with which aspirin interacts and thus affects the antiplatelet effect?
Anticoagulants: Concomitant application increases the antiplatelet effect of aspirin; therefore, the combination of the two is limited to patients with specific risk factors.
ACE inhibitors: 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.
What are some drugs that can be used as a prophylactic alternative to aspirin
In addition to aspirin, ticlopidine and clopidogrel are currently frequently used platelet aggregation inhibitors. When treatment with aspirin is contraindicated, clopidogrel may be substituted. However, the cost of treatment is increased.
Can antithrombotics be used in combination with aspirin?
Ticlopidine, clopidogrel and glycoprotein IIb/IIIa receptors have different mechanisms of action than aspirin and may have complementary effects when combined in certain diseases. These combinations may prolong the bleeding time and increase the risk of adverse effects.
What should be done in case of “treatment resistance”?
A patient is considered “treatment resistant” if he or she does not respond to the regularly recommended treatment regimen (e.g., application of standard doses). The term “treatment resistance” does not include treatment failure due to a wrong diagnosis. In this case, the patient should first be examined for indications for aspirin. For example, 70% of patients with carotid artery stenosis require surgery. In patients with cardiac vascular embolism, anticoagulants provide more effective protection. If these factors are ruled out, a change in the dose of medication should be considered to individualize the dose. Intermittent administration of high doses (e.g., 500 mg of aspirin every 14 days) in patients with a rapid rate of platelet renewal will result in improved 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 still ineffective, treatment may be changed to clopidogrel.