Aspirin is considered to be one of the three classic masterpieces in the history of medicine, along with penicillin and Valium. In the 19th century, European scientists discovered that the active ingredient of willow bark was salicylic acid, which was successfully extracted but was too irritating to the stomach. 1897, German chemist Hoffmann successfully synthesized salicylic acid by acetylation into acetylsalicylic acid, which maintained the original efficacy but greatly reduced the side effects. 1900, the German Bayer pharmaceutical factory put it into production. After the defeat of Germany in World War I and the loss of patent protection, aspirin became popular worldwide and benefited people all over the world.
Aspirin was first widely used as a painkiller in clinical practice, but later it was discovered that aspirin could inhibit platelet aggregation and prevent thrombosis, and now it is more often used in the prevention and treatment of cardiovascular diseases. However, there are many misunderstandings in the application of aspirin, and we often encounter the strange phenomenon of not using what should be used and using what should not be used in clinical practice. Aspirin is not without side effects and can lead to gastrointestinal bleeding and cerebral hemorrhage, the indiscriminate use of aspirin is harmful.
1, who must use aspirin?
People who have had an angiogram to confirm a diagnosis of coronary heart disease, myocardial infarction, stroke, peripheral vascular disease, stents and heart bypass surgery have been diagnosed with cardiovascular disease should take aspirin if it is not contraindicated. It is the responsibility of every physician to get all patients with cardiovascular disease who do not have a contraindication to aspirin to take aspirin. 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.
2, people over 40 years old without cardiovascular disease also need to take aspirin?
There is a misconception that people over the age of 45 take aspirin to prevent heart disease. Many doctors are confused as to whether people without cardiovascular disease need to take aspirin or not. There is real controversy in this area. Studies have found that in people without cardiovascular disease, daily aspirin does not reduce deaths, with a net benefit of only 5 fewer myocardial infarctions per 10,000 people per year, but 3 more severe bleeds.
Recommendations from different national and regional guidelines are also inconsistent. European cardiovascular disease prevention guidelines recommend that patients without definite cardiovascular disease do not need to take aspirin to prevent heart disease, regardless of the presence or absence of hypertension or diabetes. 2009 U.S. Prevention Task Force recommends that the cardiovascular disease prevention benefit outweighs the risk of bleeding when aspirin can be taken: (1) for men with a 10-year risk of coronary heart disease ≥ 4% in the 45- to 59-year-old group, ≥ 9% in the 60- to 69-year-old group, and ≥ 12% in the 70- to 79-year-old group ～The value of aspirin in reducing myocardial infarction will exceed the risk of gastrointestinal bleeding when ≥12% of the group is between 55 and 79 years old; (2) the value of aspirin in reducing stroke will exceed the risk of bleeding when ≥3% of the 10-year risk of stroke is in the group of 55-59 years old, ≥8% in the group of 60-69 years old, and ≥11% in the group of 70-79 years old in women. Aspirin is not recommended for people over 80 years of age without cardiovascular disease.
Our expert consensus on the regulated 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 may apply aspirin for primary prevention: (1) age 50 years or older; (2) with target organ damage, including moderately increased plasma creatinine; and (3) diabetes mellitus.
(2) Patients over 40 years of age with type 2 diabetes mellitus, combined with the following cardiovascular risk factors: (1) family history of early-onset coronary heart disease (immediate family history of onset in men <55< span=""> years and women <65< span=""> years), (2) smoking, (3) hypertension, (4) overweight and obesity, especially abdominal obesity, (5) albuminuria, and (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, ② smoking, ③ obesity, ④ >50 years old, ⑤ family history of early onset cardiovascular disease.
Remember that aspirin is a drug that can cause serious side effects such as bleeding. Not all people over 40 years of age need to take aspirin and there are strict indications for its use. An assessment of risk versus benefit is needed to determine if aspirin is needed.
3. Aspirin is one of the three life-saving bedside remedies? Is it really that amazing?
It is rumored on the Internet that aspirin is one of the three life-saving bedside remedies, 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. In the case of emergency 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 for digestive tract disease or aortic coarctation cases 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 the case of first aid, the dose should not be too small should reach 300 mg, should be chewed and taken, absorbed quickly as soon as possible to play the drug effect.
4.How long do I need to take aspirin?
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.
5.Should aspirin enteric tablets be taken on an empty stomach or after a meal?
Aspirin used to disintegrate in the stomach under the action of acidic gastric juice, causing gastrointestinal irritation and even gastric mucosal damage and bleeding, 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 that aspirin enteric tablets should be taken on an empty stomach to shorten the residence time in the stomach and reach the absorption site in the small intestine. But the prerequisite is to use enteric coated enteric aspirin tablets, which are more advantageous to import.
6, aspirin should be taken in the morning or evening?
On this issue is currently inconclusive and controversial, there is in the end is the evening or morning dosing each word. Some people believe that taking aspirin at night is more effective because platelets are more active between 2:00 pm and 10:00 am, which is also a time of high cardiovascular disease. 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 take the drug 1 hour in the morning on an empty stomach with gastrointestinal adverse reactions try to take the drug at night before bedtime.
7.What is the best dose of aspirin?
The best dose of aspirin is 75~150 mg. In clinical practice, it is often encountered 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 therapeutic effect, but only increase the side effects.
At present, imported aspirin 100 mg per tablet, one tablet a day is enough, and domestic 25 mg aspirin 3 or 4 tablets (taken at once).
8.Who is prone to gastrointestinal bleeding after taking aspirin?
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, which have a protective effect on the gastric mucosa, leading to damage and irritation of the gastrointestinal tract, which can seriously cause 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 is best to check stool occult blood every 3 months at the hospital to detect bleeding early.
9.How to take aspirin for patients who have had stents?
In clinical practice, we often encounter patients who have had stents for coronary artery disease taking double antiplatelet drugs for 12 months and then stop taking aspirin and take clopidogrel. This is incorrect. Current studies have confirmed that clopidogrel is not a substitute for aspirin for secondary prevention.