Aspirin is currently the most common drug used to prevent and treat cardiovascular and cerebrovascular diseases, and its main role is to inhibit thrombosis. Whether it is prevention before the onset of the disease or treatment after the onset of the disease, for the middle-aged and elderly, everyone knows it. Its evidence-based medical evidence and clinical efficacy are also beyond doubt.
However, there are also risks in taking aspirin, which may cause gastrointestinal ulcers, bleeding, etc., especially in patients with peptic ulcers themselves. So what if this part of the population must eat aspirin? Are there alternative drugs? The answer is yes. It is aluminum magnesium piline.
First, the composition of aluminum magnesium piline
Aluminum magnesium piline tablets (II.), is a compound preparation of aspirin, each tablet contains the drug aspirin 81mg, in addition to the buffer ingredients glycoalumin 11mg, heavy magnesium carbonate 22mg. While effectively resisting platelet aggregation, it plays a role in protecting the gastric mucosa.
Aspirin, by inhibiting COX-1 in cyclooxygenase (COX), leads to inactivation of COX-1, which in turn blocks the pathway of arachidonic acid to thromboxane A2, inhibits platelet aggregation, and thus inhibits thrombosis.
Glycolumin, chemical name dihydroxyalgasinum, is an antacid drug, clinically widely used in the treatment of gastric ulcers, duodenal ulcers, pyloric canal ulcers, chronic superficial gastritis and other diseases. Glycoalum can neutralize gastric acid, reduce gastric acidity, pepsin activity, improve clinical symptoms such as increased gastric acid and epigastric pain, and have the effect of astringent and hemostasis.
Heavy magnesium carbonate is hydrated basic magnesium carbonate, as an antacid, can reduce the adverse stimulation of aspirin to the stomach, significantly reduce the incidence of gastric mucosal erosion and ulceration, and can accelerate gastric emptying, so that aspirin quickly enters the main absorption site of the small intestine.
Second, the safety of aluminum magnesium piline
In aluminum magnesium piline tablets (II.), the aspirin content is 81mg, the relative large dose antiplatelet effect is comparable, but can reduce adverse reactions, and the same composition of aluminum magnesium piline tablets (II.) buffer type aspirin was listed in Japan in 2000, and no adverse reactions related to aluminum accumulation have been reported so far.
The risk assessment of dietary aluminum exposure of adult residents in China pointed out that the weekly tolerable intake of aluminum was 2mg per kilogram of body weight per week, and the daily tolerable intake of aluminum for adults of 50kg was 14.3mg. Aluminum magnesium pilin contains glycolumin 11mg, its molecular formula is C2H6AlNO4, contains aluminum 2.2mg, far below the daily tolerable intake, glycolumin in the presence of macromolecular complexes, rarely decomposed into ionic state of aluminum and absorbed into the blood, so the safety is better.
Third, what are the differences between aluminum and magnesium aspirin and aspirin in the prevention and treatment of cardiovascular and cerebrovascular diseases
Clinical studies have shown that there is no significant difference in the antiplatelet effect of aluminum magnesium aspirin and ordinary aspirin, but it has fewer adverse reactions than ordinary aspirin, especially in terms of reducing gastrointestinal adverse reactions. Clinically, the incidence of gastrointestinal bleeding in patients taking aluminum magnesium piline tablets and enteric-coated aspirin was evaluated clinically, and the evaluation indicators included the gastrointestinal bleeding rate in all patients, the rate of hemoglobin reduction caused by suspected small intestinal bleeding, and the cardiovascular mortality from taking low-dose aspirin for more than 1 year. The results found that the incidence of suspected small intestinal bleeding in patients with enteric-coated aspirin was higher than that of aluminum magnesium piline tablets.
Aluminum magnesium piline can solve the problem of patients who have difficulty to tolerate aspirin digestive tract stimulation in the clinic, and has a more significant protective effect on the small intestine. It is clinically recommended that aluminum magnesium piline tablets (II.) be used in people who need aspirin for primary and secondary prevention of cardiovascular and cerebrovascular diseases. The so-called primary prevention refers to the prevention before the absence of cardiovascular disease, and the secondary prevention refers to the prevention of recurrence that has been accompanied by cardiovascular disease. It is recommended that people at risk of gastrointestinal injury give priority to the use of aluminum magnesium piline tablets (II.).
Aspirin primary prevention trials in patients with diabetes showed that daily use of small doses of aspirin (81 to 100 mg) reduced coronary and cerebrovascular event mortality by 90% in patients with diabetes mellitus, and the incidence of primary endpoint events in elderly patients with diabetes over 65 years of age was reduced by 32%. In older people >60 years of age with risk factors such as diabetes, hypertension, or hypercholesterolemia, aspirin reduced nonfatal myocardial infarction events by 47 percent and transient ischemic attacks by 43 percent.
The U.S. Diabetes Guidelines recommend that patients with high-risk diabetes can use aspirin for primary prevention, taking into account the differences in cardiovascular risk in different age groups, the 2016 U.S. Guidelines recommend that 50 to 59 years old, 10 years of cardiovascular disease risk ≥ 10% of the population use low-dose aspirin for the primary prevention of cardiovascular disease, the most common prescription of aspirin in the United States is 81mg. Reduces all-cause mortality, cardiovascular mortality, and major cardiovascular events, including myocardial infarction, all-cause stroke, and ischemic stroke.
A meta-analysis published by the American Antithrombotic ExperimentAtion Group showed that secondary prevention of aspirin can reduce severe vascular events and reduce non-fatal myocardial infarction, nonfatal cerebral infarction, and vascular mortality. It is recommended that aspirin 162 to 325 mg should be given before percutaneous coronary intervention (PCI) and 81 to 162 mg as a maintenance dose after PCI. For patients with stable coronary heart disease, aspirin should be taken daily. Aspirin (50 to 325 mg/day) alone or 25 mg aspirin plus dipyridamole 200 mg twice daily can be used as the initiation of treatment for the prevention of transient ischemic attacks and recurrence of ischemic stroke.
In summary, clinical studies have shown that small doses of aspirin and large doses of aspirin are equally effective against platelets, and there is no statistical difference in the prevention and treatment of myocardial infarction, cerebral infarction, and major adverse cardiovascular and cerebrovascular events. At the same time, small doses reduce the adverse effects of larger doses of aspirin. 81 mg of aspirin is the most commonly prescribed dose in the United States and is both practical and evidence-based scientific. Patients at high risk of peptic ulcer or bleeding may be given preference for aluminum-magnesium-aspirin when they have to use aspirin.