A*******s
发帖数: 9638 | 1 现在的阿司匹林好像跟维生素一样广泛使用。 今天有个病人跟我说，反正没有什么副
作用，吃了可以防止心脏病和中风。 没有副作用是不正确的，当然小剂量应该没太大
问题。 问题是什么人该吃，什么人不该吃？吃了又怎么样？这个问题肯定是仁者见仁
，智者见智。
对中风的预防，我主张有症状的病人服用， 比方说TIA和stroke病人。 但如果临床上
病人有高风险发生中风，比方说众多的中风危险因素以及MRI的发现，我会使用阿司匹
林。 其他没有症状的病人，我是反对使用的，因为阿司匹林还是有副作用的， 而且没
有足够证据证明ASA可以预防原发中风。
对心血管医生来说，他们有他们的标准，病人使用阿司匹林是为了预防冠心病，与中风
预防无关。 Garland或其他心脏病医生可以谈谈你们的使用原则。
下面是一些关于ASA的使用guidelines：
1. The use of aspirin for cardiovascular (including but
not specific to stroke) prophylaxis is recommended
for persons whose risk is sufficiently high for the
benefits to outweigh the risks associated with treatment
(a 10-year risk of cardiovascular events of 6%
to 10%) (Class I; Level of Evidence A).
2. Aspirin (81 mg daily or 100 mg every other day) can
be useful for prevention of a first stroke among
women whose risk is sufficiently high for the benefits
to outweigh the risks associated with treatment
(Class IIa; Level of Evidence B).
3. Aspirin is not useful for preventing a first stroke in
persons at low risk (Class III; Level of Evidence A).
4. Aspirin is not useful for preventing a first stroke in
persons with diabetes or diabetes plus asymptomatic
peripheral artery disease (defined as an ankle brachial
pressure index <0.99) in the absence of other
established CVD (Class III; Level of Evidence B). |
n*******c
发帖数: 501 | 2 I suspect most people mix the concept of primary and secondary prevention.
Aspirin has good evidence in terms of secondary prevention but not primary
prevention. It depends on the estimation of risk of vascular events and
bleeding in a real case.
Also Framingham risk score is probably overestimating risk
for Chinese population and needs some calibration. |
B******f
发帖数: 2489 | 3 很好的讨论
家慈97年stroke一次，之后就是阿司匹林和中药（好像主要是丹参）轮着吃。因为
paternal family一支得stroke的很多，家严也跟着吃这些。n年了，天天吃，真跟吃维
生素似的 |
i***c
发帖数: 301 | 4 我老头之前喝一瓶酒后摔一绞，头撞花盆
后来被神经内科开了阿司匹灵服用后左脚不利
一月后入院未ct挂了灯盏细辛三天后昏迷
做了第一次开颅手术
后来手术伤口又未愈，人工脑膜排异，第二次手术，脑脓肿，抗生素一天1000元
半年后现在好像好了，但颅骨缺损，悲剧，现在想阿司匹灵是一大因素啊
好大夫上的说法：
http://www.haodf.com/wenda/tianfuming_g_634594107.htm
"您好！今年来老年人口服阿司匹林并发慢性硬模下血肿的（轻微外伤或根本没有外伤
）很
多，建议您还是停了阿司匹林吧！心内科、神经内科医师一般会建议口服阿司匹林，但神
经外科医生反对，因为阿司匹林诱发的脑出血太多了。建议您多饮水、多食蔬菜、水果
（血糖不高的话）、常食海产品、适度锻炼、可口服维生素E、深海鱼油即可有效预防
血栓
形成。谢谢！" |
J*********4
发帖数: 1274 | 5
===
您家先生的问题是外伤后慢性硬模下血肿, 但是头部外伤之后不能用阿司匹灵。
【在 i***c 的大作中提到】
: 我老头之前喝一瓶酒后摔一绞，头撞花盆
: 后来被神经内科开了阿司匹灵服用后左脚不利
: 一月后入院未ct挂了灯盏细辛三天后昏迷
: 做了第一次开颅手术
: 后来手术伤口又未愈，人工脑膜排异，第二次手术，脑脓肿，抗生素一天1000元
: 半年后现在好像好了，但颅骨缺损，悲剧，现在想阿司匹灵是一大因素啊
: 好大夫上的说法：
: http://www.haodf.com/wenda/tianfuming_g_634594107.htm
: "您好！今年来老年人口服阿司匹林并发慢性硬模下血肿的（轻微外伤或根本没有外伤
: ）很
|
i***c
发帖数: 301 | 6 外伤后不能用有依据？那我们要起诉之，一年前事不知道过了时效
有无中文教材或规程药品使用上规定，指点一下 |
J*********4
发帖数: 1274 | 7
－－－－－－－
我没有任何的权威性，其实也是一知半解。
请医疗事故鉴定专家问问吧。
【在 i***c 的大作中提到】
: 外伤后不能用有依据？那我们要起诉之，一年前事不知道过了时效
: 有无中文教材或规程药品使用上规定，指点一下
|
f**********n
发帖数: 246 | 8 Studies also prove taking ANA decrease risk of colon cancer by about 30 % |
A*******s
发帖数: 9638 | 9 link？
So everyone should take asa after age 50 instead of being scoped? :)
【在 f**********n 的大作中提到】
: Studies also prove taking ANA decrease risk of colon cancer by about 30 %
|
J*********4
发帖数: 1274 | 10
=====
http://www.nejm.org/doi/pdf/10.1056/NEJM199112053252301
https://secureweb.mcgill.ca/cancerepi/sites/mcgill.ca.cancerepi/files/
Giovanucci-NEJM.pdf
http://nccrtreview.fe-works.com/Documents/JournalArticles/Aspir
Strange but true:)
Aspirin reduces the risk of colon cancer, via inhibition of cox-2. Recent
data indicate Aspirin might selective inhibit colon cancer haboring PIK3CA
mutation.
http://www.nejm.org/doi/full/10.1056/NEJMc1214189?viewType=Prin
【在 A*******s 的大作中提到】
: link？
: So everyone should take asa after age 50 instead of being scoped? :)
|
|
|
A*******s
发帖数: 9638 | 11 Thanks. It is still secondary prevention. Otherwise, 30% is huge.
【在 J*********4 的大作中提到】
:
: =====
: http://www.nejm.org/doi/pdf/10.1056/NEJM199112053252301
: https://secureweb.mcgill.ca/cancerepi/sites/mcgill.ca.cancerepi/files/
: Giovanucci-NEJM.pdf
: http://nccrtreview.fe-works.com/Documents/JournalArticles/Aspir
: Strange but true:)
: Aspirin reduces the risk of colon cancer, via inhibition of cox-2. Recent
: data indicate Aspirin might selective inhibit colon cancer haboring PIK3CA
: mutation.
|
d**o
发帖数: 618 | 12 我比较糊涂这个心血管病方面primary/secondary到底如何定义？Atherosclerotic
fatty streak 30岁就开始有，50岁以上男的基本全有，那按fatty streak来看这个
disease50岁以上男的基本全有，岂不是无论你对50岁以上男的做什么，都是secondary
而不是primary？ |
A*******s
发帖数: 9638 | 13 atherosclerosis人人都可以有，但只有少数人会有heart attack
primary prevention是指预防没有过心梗的病人得心梗。 prevent heart attack not
atherosclerosis。
secondary
【在 d**o 的大作中提到】
: 我比较糊涂这个心血管病方面primary/secondary到底如何定义？Atherosclerotic
: fatty streak 30岁就开始有，50岁以上男的基本全有，那按fatty streak来看这个
: disease50岁以上男的基本全有，岂不是无论你对50岁以上男的做什么，都是secondary
: 而不是primary？
|
d**o
发帖数: 618 | 14 谢谢解释。那如果primary/secondary的定义只是针对某个acute event，我觉得说服力
并不足啊。比如，完全有可能aspirin延缓了粥样斑的生长，但对防止embolus脱落没有
作用，所以不能减少the incidence of first heart attack/stroke，但却减少了the
size of clot during the first attack，结果first attack之后的ischemia程度和预
后比不服aspirin要好，从长远上来讲延长了寿命？即使对low-risk, 如果考虑
benefits只考虑primary prevention是否不足够？假如有针对low-risk的长期aspirin
服用跟踪，end-point is mortality or permanent disability rather than first
attack，最后发现并不能延寿，我觉得更有说服力。
not
【在 A*******s 的大作中提到】
: atherosclerosis人人都可以有，但只有少数人会有heart attack
: primary prevention是指预防没有过心梗的病人得心梗。 prevent heart attack not
: atherosclerosis。
:
: secondary
|
d**o
发帖数: 618 | 15 随便搜了一下，貌似这篇文章跟我想到一起了，然后声称aspirin对降低mortality有用。
http://www.ncbi.nlm.nih.gov/pubmed/21592450
OBJECTIVE: The lack of a mortality benefit of aspirin in prior meta-analyses
of primary prevention trials of cardiovascular disease has contributed to
uncertainty about the balance of benefits and risks of aspirin in primary
prevention.
Conclusions (at end of article): Our results demonstrate a consistent
pattern of reduced mortality in all of the aspirin primary prevention trials
and a significant, albeit modest, reduction in all-cause mortality when the
data are pooled. This reduction in all-cause mortality tilts the balance
between the benefits and risks of treatment in favor of the use of aspirin. |
d**o
发帖数: 618 | 16 反方意见来了，看来还会有一段时间的争议，不过大体看来，aspirin对low-risk的
primary prevention之外的benefits，即使有也会是比较小的。
http://www.sciencedirect.com/science/article/pii/S0002934311008
I read with interest the meta-analysis of trials of aspirin for the primary
prevention of cardiovascular disease.1 After almost 1 million person-years'
follow-up, >3500 deaths, and almost 4000 cardiovascular events, treatment
with aspirin might have prevented 21 deaths, possibly none cardiovascular,
88 myocardial infarctions, and 13 strokes, and may have caused 387 major
gastrointestinal hemorrhages. Incredibly, the authors believe this analysis
should persuade people to take, rather than avoid, aspirin. If the data on
mortality were true, that might just be justified. However, confidence
intervals barely exclude the null effect.
The authors did not include the Pulmonary Embolism Prevention Trial that
enrolled 17,444 patients without overt cardiovascular disease undergoing
surgery for hip fractures or elective arthroplasty.2 Aspirin reduced deep
venous thrombosis but not deaths (456 on aspirin vs 472 on placebo). There
was an increase in myocardial infarctions with aspirin (115 vs 86; P = .05). |
A*******s
发帖数: 9638 | 17 I got you but it is complicated.
1. The targets of primary and secondary prevention are different.
2. Mortality is also different from acute event. People could survive from
an heart attck but die from colon cancer.
the
aspirin
【在 d**o 的大作中提到】
: 谢谢解释。那如果primary/secondary的定义只是针对某个acute event，我觉得说服力
: 并不足啊。比如，完全有可能aspirin延缓了粥样斑的生长，但对防止embolus脱落没有
: 作用，所以不能减少the incidence of first heart attack/stroke，但却减少了the
: size of clot during the first attack，结果first attack之后的ischemia程度和预
: 后比不服aspirin要好，从长远上来讲延长了寿命？即使对low-risk, 如果考虑
: benefits只考虑primary prevention是否不足够？假如有针对low-risk的长期aspirin
: 服用跟踪，end-point is mortality or permanent disability rather than first
: attack，最后发现并不能延寿，我觉得更有说服力。
:
: not
|
