二甲双胍联合小剂量阿司匹林治疗复发性流产伴胰岛素抵抗的临床疗效

目的：观察二甲双胍联合小剂量阿司匹林治疗复发性流产伴胰岛素抵抗患者的临床疗效。方法：本研究纳入90 例复发性流产伴胰岛素抵抗患者,随机分为三组,即基础干预组、二甲双胍组（基础干预+二甲双胍组）、观察组（基础干预+二甲双胍+小剂量阿司匹林组）。治疗三个月后评估并比较三组患者的身体质量指数（BMI）、稳态模型胰岛素抵抗指数（HOMA-IR）、纤溶酶原激活物抑制剂（PAI-1）、同型半胱氨酸（HCY）、空腹胰岛素（FINS）水平及治疗后半年内的妊娠率。结果：与治疗前相比,三组治疗后BMI、HOMAIR、FINS均下降,差异有统计学意义（P ＜0.05）,且观察组与基础干预组比较差异有统计学意义（P ＜0.05）,但与二甲双胍组相比差异无统计学意义（P ＞0.05）;治疗后三组血清PAI-1、HCY水平均降低,观察组下降明显,与二甲双胍及基础干预组相比差异均有统计学意义（P ＜0.05）;观察组和二甲双胍组治疗后半年内 妊娠率与基础干预组比较差异均有统计学意义（P ＜0.05）,但两组间差异无统计学意义（P ＞0.05）。结论：二甲双胍联合小剂量阿司匹林可改善复发性流产伴胰岛素抵抗患者的胰岛素抵抗状态,降低患者的血清PAI-1、HCY水平,提高临床妊娠率,且不良反应较少。     

降纤酶和阿司匹林治疗频发短暂性脑缺血发作55例疗效观察

目的：探讨降纤酶和阿司匹林治疗频发短暂性脑缺血发作的效果。方法：对55例频发短暂性脑缺血发作患者应用降纤酶和阿司匹林治疗的临床资料进行分析。结果：降纤酶和阿司匹林治疗频发短暂性脑缺血发作患者后TIA停止时间短于单用其中一种药物（P〈0．05）。治疗后全血高切黏度、纤维蛋白原、血小板聚集率比治疗前明显改善,治疗前后差异有显著性（P〈0．05）。结论：降纤酶和阿司匹林治疗频发短暂性脑缺血发作比单一治疗快捷有效。     

Highlighting the Roles of Anemia and Aspirin in Predicting Ninety-Day Readmission Following Aseptic Revision Total Joint Arthroplasty

BackgroundRevision total joint arthroplasties (TJAs) are associated with an increased rate of complications. To date, it is unclear what drives readmission after aseptic revision arthroplasty and what measures can be taken to possibly avoid them. The purpose of this study is to (1) determine the reasons for readmission after aseptic revision TJA and (2) identify patient-specific or postoperative risk factors through a multivariate analysis.MethodsA retrospective study examined 1503 cases of aseptic revision TJA between 2009 and 2016 at an urban tertiary care hospital. Eighty-seven cases (5.8%) of readmission within 90 days of index surgery were identified. Bivariate and multivariate analyses were performed to assess independent risk factors for readmission.ResultsThe reasons for readmission were infection (38%), wound complications (22%), and dislocation/instability of the prosthetic joint (13%). Only preoperative anemia was associated with an increased odds ratio (OR) of readmission (OR 1.82, 95% confidence interval [CI] 1.126-2.970, P = .015), whereas postoperative venous thromboembolism prophylaxis with aspirin (OR 0.58, 90% CI 0.340-0.974, P = .039) and discharge to an inpatient rehab facility (OR 0.22, 95% CI 0.051-0.950, P = .042) were associated with significantly lower odds of readmission.ConclusionBased on this single institutional study, addressing preoperative anemia and considering the implementation of aspirin for venous thromboembolism prophylaxis may be 2 targets to potentially reduce readmission after aseptic revision TJA.     

伊班膦酸钠联合阿司匹林对冠心病合并骨质疏松症骨密度及骨代谢的影响

目的 观察伊班膦酸钠联合阿司匹林对绝经期冠心病患者骨密度及骨生化和代谢的影响。方法 89例绝经后冠心病患者,按随机数字表法将其分为治疗组(n=44)、对照组(n=45)。治疗组给予伊班膦酸钠联合阿司匹林治疗,治疗期12个月。对照组给予阿司匹林治疗。测定治疗不同时间段患者,腰椎L1~ 4、左股骨颈、Ward三角骨密度及血清钙(Ca)、血磷(P)、1,25-(OH)2D3、甲状旁腺激素(PTH)、I型胶原交联C末端肽(CTX)及骨特异性碱性磷酸酶(BALP)水平的变化情况。结果 治疗12个月后,两组患者的骨密度都有不同程度提高,治疗组腰椎L1~4、左股骨颈、Ward骨密度均显著高于同时期对照组(P <0.05);治疗12个月后,两组患者的血清CTX水平都有不同程度下降,BALP明显上升(P＜0.05),而治疗组改变明显高于同期对照组(P＜0.05),血清钙(Ca)、血磷(P)、1,25-(OH)2D3、甲状旁腺激素(PTH)无明显改变(P＞0.05)。结论 伊班膦酸钠联合阿司匹林能提升绝经期冠心病患者骨密度,改善骨生化和代谢状态。     

Repeated Doses of Combined Oral Lysine Acetylsalicylate and Metoclopramide in the Acute Treatment of Migraine

The combination of lysine acetylsalicylate and metoclopramide is effective in the treatment of migraine attacks. It was unknown whether repeated doses could improve efficacy.
The aim of this open trial was to evaluate the effects of a second, and eventually a third dose of lysine acetylsalicylate and metoclopramide when a first dose of the treatment was ineffective. Patients were asked to take a second dose 2 hours after a first dose when they thought that the first dose was ineffective. They were allowed to take a third dose or their rescue medication 2 hours after the second dose when they judged that the treatment remained ineffective.
Two hundred ninety-two patients were included in the study; 262 of the 292 patients treated 517 attacks.
Headache relief (reduction in headache severity from grade 3 or 2 to grade 1 or 0) was observed in 54.8% of attacks after one dose, in 48.1% of attacks after a second dose, and in 40.3% of attacks after a third dose.
Complete headache relief without recurrence and without use of a rescue medication was reported in 37% of the total attacks.
The patients judged their treatment as good or excellent in 78% of attacks treated with one dose, in 41% of those treated with two doses, and in 19% of those treated with three doses.
Tolerance, as judged by the patients, was considered good in 92% of treated attacks. Minor side effects occurred in 6% of attacks after a first dose, in 4.5% of attacks after a second dose, in 1.5% of attacks after a third dose, in 2% after unspecified delay, and in 14% overall.
In conclusion, the efficacy of lysine acetylsalicylate and metoclopramide in the treatment of migraine attacks can be improved by repeated doses. It is well tolerated.     

Aspirin ‘resistance’: role of pre‐existent platelet reactivity and correlation between tests

Summary. Background: Aspirin ‘resistance’ is a widely used term for hyporesponsiveness to aspirin in a platelet function test. Serum thromboxane (TX) B₂ is the most specific test of aspirin’s effect on platelets. Objectives: (i) To examine the role of pre‐existent platelet hyperreactivity in aspirin ‘resistance’. (ii) To determine the correlation between aspirin resistance defined by serum TXB₂ and other assays of platelet function. Methods: To enable pre‐aspirin samples to be drawn, platelet function was measured in normal subjects (n = 165) before and after aspirin 81 mg daily for seven days. Results: The proportion of the post‐aspirin platelet function predicted by the pre‐aspirin platelet function was 28.3 ± 7.5% (mean ± asymptotic standard error) for serum TXB₂, 39.3 ± 6.8% for urinary 11‐dehydro TXB₂, 4.4 ± 7.7% for arachidonic acid‐induced platelet aggregation, 40.4 ± 7.1% for adenosine diphosphate‐induced platelet aggregation, 26.3 ± 9.2% for the VerifyNow Aspirin Assay^®, and 45.0 ± 10.9% for the TEG^® PlateletMapping? System with arachidonic acid. There was poor agreement between aspirin‐resistant subjects identified by serum TXB₂ vs. aspirin‐resistant subjects identified by the other five assays, irrespective of whether the analysis was based on categorical or continuous variables. Platelet count correlated with pre‐aspirin serum TXB₂ and VerifyNow Aspirin Assay, but not with any post‐aspirin platelet function test. Conclusions: (i) Aspirin ‘resistance’ (i.e. hyporesponsiveness to aspirin in a laboratory test) is in part unrelated to aspirin but is the result of underlying platelet hyperreactivity prior to the institution of aspirin therapy. (ii) Aspirin resistance defined by serum TXB₂ shows a poor correlation with aspirin resistance defined by other commonly used assays.     

Low-dose aspirin for the prevention of venous thromboembolism in breast cancer patients treated with infusional chemotherapy after insertion of central vein catheter

BACKGROUND: We previously demonstrated a high incidence (7.7%) of venous thromboembolism (VTE) in breast cancer patients treated with infusional chemotherapy after insertion of central vein catheters (CVC). The aim of this study was to evaluate the efficacy and safety of low-dose aspirin for the prevention of VTE. PATIENTS AND METHODS: In a monocentric prospective study, patients with stage II-IV breast cancer, who underwent CVC insertion for continuous infusional chemotherapy, were assigned to receive low-dose aspirin (100 mg daily). Treatment was started after CVC implantation and continued until the last day of chemotherapy. Patients were assessed for safety and for the incidence of symptomatic deep venous thrombosis (DVT) confirmed by color-Doppler ultrasonography. RESULTS: Between April 2000 and March 2004, 188 consecutive patients were included in the study. Median age was 48 years (range 22-83), 31 patients (16%) had concomitant hypertension, and 14 patients (7.4%) were smokers. Median duration of treatment with aspirin was 3.6 months (range 0.4-5.7). A DVT confirmed by color-Doppler ultrasonography was observed in four patients (2.1%; 95% confidence interval, 0.58-5.35%). Side effects included mild epistaxis (three patients, 1.5%) and mild gastric pain (two patients, 1%). No major bleeding complication or International Normal Ratio alteration occurred. CONCLUSIONS: Administration of low-dose aspirin is safe and seems to correlate with a low risk of DVT in breast cancer patients treated with infusional chemotherapy. Further randomized studies comparing low-dose aspirin with other anticoagulative agents are warranted.