"Doesn't it mean that aspirin can prevent stroke, and how do I get stomach bleeding?"
Mr. Ma, 39 years old, was found to have high blood pressure during a physical examination about three years ago. Since the detection of high blood pressure, he was very scared in his heart, always listening to others say that it is easy to have a heart attack, cerebral infarction, and then he accidentally found that a relative had a stroke before and was eating aspirin to prevent blood clots, so he also began to take aspirin, eating one tablet every morning and one tablet at night.
After eating for several years, about a week ago, Mr. Ma suddenly had abdominal pain, and then was rushed to the hospital, the doctor did a gastroscopy, and found that Mr. Ma's stomach was bleeding, and there were multiple ulcers.
After a detailed consultation, the doctor learned that Mr. Ma had been taking aspirin for a long time, so he diagnosed that aspirin caused acute stomach bleeding.
These Mr. Ma wondered, didn't aspirin prevent blood clots and heart attacks? Why do you eat stomach bleeding instead? The doctor told him that not everyone is suitable for aspirin, needs to be professionally evaluated, and that every year there are many patients like Mr. Ma who abuse aspirin and bleed in the stomach.
Aspirin was born in 1899, more than a hundred years ago, has been regarded as a cardiovascular medicine, it can prevent platelets in the blood vessels piling, prevent thrombosis, even in the fight against cancer has the potential, but also recommended by doctors to many patients. But a growing body of research suggests that aspirin is not for everyone.
First, the new statement of the United States: there is no cardiovascular disease, and it is not recommended to take aspirin for people over 60 years old
Recently, the U.S. Preventive Services Task Force issued a new statement on the primary prevention of aspirin in atherosclerotic cardiovascular disease, recommending that low-dose (81 mg) aspirin be used as a primary prevention of cardiovascular disease in adults aged 40-59 years, with a 10-year risk of cardiovascular disease ≥ 10%, which should be individualized, at its own discretion, and it is not recommended to use low-dose aspirin as a primary prevention of cardiovascular disease in adults ≥ 60 years old.
Why are the recommendations for aspirin updated?
By assessing the net benefits of primary prevention with medication, the working group found that:
1. 1. 10% of adults aged 40 to 59 years with a 10-year risk of cardiovascular disease ≥ had a small net benefit from primary prevention with aspirin.
2. There is no net benefit for primary prevention of aspirin in adults aged ≥ 60 years old, and the risk of bleeding is greater.
3. According to the latest analysis of 24 recent analyses of evidence from major cardiovascular disease prevention populations, 14 studies and long-term follow-up data from the Women's Health Study (WHS), statistics show that low-dose aspirin has insufficient evidence for reducing colorectal cancer incidence or mortality.
Second, long-term consumption of aspirin, these side effects are very important
Although aspirin has a wide range of use, good effect, and is also the preferred drug to prevent thrombosis, its adverse reactions cannot be ignored.
1. Bleeding
The general dose of aspirin inhibits platelet aggregation and prolongs bleeding time, but prolonged or high-dose aspirin can prolong clotting time and cause bleeding.
2. Hurt the stomach
High doses of aspirin can cause epigastric discomfort, heartburn, induce and aggravate ulcers, and can irritate the brain, causing nausea and vomiting.
3. Kidney injury
Aspirin can cause symptoms of impaired tubular function such as edema in a small number of patients with impaired heart, liver, and renal function.
4. Allergies
Some patients have urticaria, angioedema and even anaphylactic shock after taking aspirin, and a small number of patients take it to induce asthma.
5. Salicylic acid reaction
After taking aspirin, if there is headache, dizziness, nausea, vomiting, high fever, sweating, etc., it is likely that salicylate poisoning reactions occur after taking the drug, and the drug should be stopped immediately.
Third, do you still want to eat aspirin? 3 categories of people should not take
Before answering the question, let's see what Chinese their own research says.
In the Chinese Guidelines for primary prevention of cardiovascular disease, the use of aspirin is only recommended that patients aged 40 to 70 years with a high risk of atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease, myocardial infarction, heart failure, stroke, etc.) with at least 1 risk enhancing factor but no risk of high-risk bleeding may be considered for primary prevention of ASCVD with low-dose aspirin (70 to 100 mg/day).
The use of primary aspirin prevention is not recommended in the following 3 types of people:
1. Medium- and low-risk patients with atherosclerotic cardiovascular disease;
2. Patients who are less than 40 years old and older than 70 years old;
3. Patients with high risk of bleeding after evaluation.
Huang Jiawen, a pharmacist in charge of the First Affiliated Hospital of Jinan University, once said that patients who already have cardiovascular diseases still need to take aspirin according to their condition and follow the doctor's instructions, and cannot stop the drug at will. Especially in patients who have had a cardiac bypass, cardiac stent, or have had ischemic stroke, the benefits of taking aspirin far outweigh the risk of bleeding, and do not stop the drug without authorization. For people who do not have the disease, the risk is relatively low, and there is no heart discomfort, it is generally not recommended to take aspirin prophylaxis.
Fourth, protect the heart but hurt the stomach, afraid that you will not use it correctly
Although aspirin is quite successful in preventing cardiovascular and cerebrovascular diseases, it is not a elixir, and these precautions must be paid attention to before taking:
1. Before eating, it needs to be professionally evaluated by a doctor
Before taking the drug, it needs to be evaluated by a doctor before taking it according to the dose. If the doctor's risk assessment of the patient's heart disease or stroke is not accurate, the role of aspirin prevention cannot be played.
2. Strictly follow the dosage, and do not make up for it once or twice
A large number of data comprehensive analysis found that 50-100 mg per day (mostly recommended 75 mg per day) aspirin is a suitable dose for long-term use, which can achieve the best preventive effect and reduce drug toxicity.
In addition, aspirin inhibits platelets permanently, unless it is a platelet resurgence. About 10% of platelets are regenerated every day, so missing 1 or 2 doses of aspirin has no significant effect on the prevention of thrombosis, and there is no need to deliberately increase the amount of supplementation.
3. Avoid taking and taking some drugs
Aspirin will interact with other drugs, taken with vitamin B1, can increase the patient's gastrointestinal response; taking with diuretics, easy to cause salicylic acid poisoning; combined with anticoagulants, easy to lead to bleeding risk; combined with adrenocortical hormones, easy to induce ulcers.
4. The discontinuation of the drug should be carried out under the guidance of the doctor
Patients who have been taking aspirin for a long time, such as sudden discontinuation of the drug for some reason (such as surgery, tooth extraction, bleeding or allergies, failure to follow the doctor's advice, etc.), will induce new cardiovascular events in a short period of time. Therefore, it should be done under the guidance of a doctor before discontinuing the drug.
5. Seek medical treatment in time if there is an adverse reaction
Any epigastric discomfort during medication, such as nausea, vomiting, abdominal pain, bloating, anorexia, acid reflux, belching, heartburn, burning sensation, etc.; or hematoma, epistaxis, genitourinary bleeding, bleeding gums, etc., should be seen in time.
Although aspirin is a primary preventive drug for cardiovascular disease, it has a clear adverse reaction to the digestive tract, and there are stomach bleeding and even fatal side effects. Therefore, before taking the drug, be sure to communicate with the doctor or pharmacist about your own situation and adjust the treatment plan in time. #头号周刊 #
Resources:
[1] US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022, 327(16): 1577-1584.
Chinese guidelines for primary prevention of cardiovascular disease[J].Journal of Practical Cardiovascular and Cerebrovascular Diseases,2021,29(01):44+64.
[3] Can aspirin still be eaten when it comes down from the "altar"? The First Affiliated Hospital of Jinan University.2019-03-15
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