Antiplatelet therapy for postdischarge medical management of acute coronary syndrome

Postdischarge management of patients with acute coronary syndrome is often suboptimal, despite their high risk of a subsequent event. Updated American College of Cardiology/American Heart Association guidelines emphasize the need for aggressive modification of risk factors and treatment with antiplatelet, antihypertensive, and lipid-lowering agents commenced in-hospital and continued long-term. Antiplatelet therapy involving aspirin and clopidogrel is the mainstay of secondary risk reduction. Increased adherence to medication and risk factor modification at discharge has been demonstrated with acute care quality improvement initiatives. Extension of these initiatives to postdischarge care will provide data on medication adherence post acute coronary syndrome and functional outcomes in the community setting. Successful secondary prevention of cardiovascular events requires implementation of evidence-based guidelines by physicians, and adherence to pharmacotherapy and lifestyle modifications by patients. Primary care physicians are well placed to influence adherence through their ongoing relationships with patients and can save lives by implementing secondary risk reduction measures after discharge.     

阿司匹林对CKD3期患者肾功能影响的探讨

目的:阿司匹林属非甾体类抗炎药,常期以来被认为具有肾毒性。本文选取肾脏疾病中数量较多的慢性肾脏病(CKD)3期患者为观察对象,探讨阿司匹林对肾功能的影响。方法:选取2012年3月~2013年3月于我科门诊随访且资料完整的CKD3期患者。服用阿司匹林的指征为轻度头晕及胸闷(包括心电图ST-T改变),且无反指征(如上消化出血和严重溃疡病)。患者随机进入阿司匹林组(100 mg/d)和空白对照组,随访6个月。主要观查血小板聚集功能(ADP诱导法)、血肌酐(Scr)水平和肾小球滤过率(e GFR)(EPI及MDRD公式计算)以及尿蛋白量的变化。结果:最终进入统计的患者为36例(每组各为18例),其中男22例,女14例,平均年龄(56.6±9.8)岁,Scr(121.8±26.1)μmol/L,e GFR(53.4±12.3)ml·min-1·1.73 m-2(EPI公式),e GFR(50.5±10.3)ml·min-1·1.73 m-2(MDRD简化公式),24 h尿蛋白(0.748±0.27)g。(1)治疗前两组患者年龄、身体质量指数(BMI)、血压、血小板计数、血尿素(BUN)、Scr、e GFR(EPI及MDRD公式计算)、24 h尿蛋白和尿白蛋白/尿肌酐比(ACR)差异均无统计学意义。(2)治疗前与治疗后3月、6月两组e GFR(EPI及MDRD公式计算)比较均差异无统计学意义(P0.05);两组治疗前后EPI和MDRD自身比较也差异无统计学意义(P0.05)。(3)治疗前、治疗后3月和6月两组24 h尿蛋白比较差异无统计学意义(P0.05),两组治疗前后24 h尿蛋白自身比较也差异无统计学意义(P0.05)。治疗后3月和6月两组ACR和尿红细胞比较也差异无统计学意义(P0.05)。(4)治疗后3月和6月,阿司匹林组血小板聚集功能较对照组明显下降(3月64.6∶74.9,6月61.9∶75.1),P=0.000。(5)阿司匹林组:血小板聚集功能治疗后3月和6月较治疗前明显下降(3月64.6∶74.4,6月61.9∶74.4),P=0.000,而对照组没有明显变化。(6)两组治疗后粪隐血均为阴性,两组治疗后3月和6月腹痛差异无统计学意义。结论:阿司匹林对CKD3期患者肾功能没有明显影响,可安全使用。     

Aspirin in the primary prophylaxis of venous thromboembolism in surgical patients

IntroductionVenous thromboembolism (VTE) is a common complication in surgical patients, especially those undergoing lower limb orthopaedic procedures as well as oncological resectional surgery. Numerous studies have evaluated the role of acetylsalicylic acid (ASA, aspirin) in primary VTE prevention, with contradictory results reflected in divergent guidelines. We reviewed current evidence for ASA as primary VTE prophylaxis.MethodsEnglish language studies meeting our inclusion criteria were retrieved from PubMed, EMBASE and Cochrane databases. Six studies (3 meta-analyses and 3 randomized trials) comparing ASA with placebo and 7 studies (1 meta-analysis, 5 randomized trials, and 1 prospective) comparing ASA with other anticoagulants were included in the final analysis. Retrospective studies and case reports were excluded.ResultsASA is more effective than placebo in primary VTE prevention. Although there is clinical equipoise when ASA is compared with other anticoagulants, studies specific to orthopaedic surgery suggest that ASA appears as effective as low molecular weight heparin (LMWH) and may reduce bleeding risk. Extended prophylaxis up to 4 weeks post surgery reduces VTE episodes.ConclusionsASA may be considered as a potential strategy in primary VTE prophylaxis in orthopaedic patients at high-risk of bleeding complications. Further studies comparing ASA with LMWH/oral anticoagulants in primary thromboprophylaxis following non-orthopaedic surgery are warranted.     

COXIBs and non-selective NSAIDs in the gastroenterological setting: What should patients and physicians do?

Although adverse effects of nonsteroidal anti-inflammatory drugs occur in only a small proportion of users, the widespread use of these drugs has resulted in a substantial overall number of affected persons who experience serious gastrointestinal complications. Dyspeptic symptoms are estimated to occur in 10-60% of nonsteroidal anti-inflammatory drug users and lead to discontinuation of treatment in 5-15% of rheumatoid arthritis patients taking nonsteroidal anti-inflammatory drugs. It is now well established that the point prevalence of peptic ulcer disease in patients receiving conventional nonsteroidal anti-inflammatory drug therapy ranges between 10 and 30%, representing a 10- to 30-fold increase over that found in the general population. One out of 175 users of conventional nonsteroidal anti-inflammatory drugs in the USA will be hospitalized each year for nonsteroidal anti-inflammatory drug-induced gastrointestinal damage. The mortality of hospitalized patients remains about 5-10%, with an expected annual death rate of 0.08%. The selective COX-2 inhibitors consistently show comparable efficacy to that of conventional nonsteroidal anti-inflammatory drugs in patients with rheumatoid arthritis and osteoarthritis, but have a reduced propensity to cause gastrointestinal toxicity. In many cases, the gastric effects of therapeutically active doses of COX-2 inhibitors are indistinguishable from placebo. The safety benefits of COX-2 inhibitors given alone appear similar to those of combined therapy with conventional nonsteroidal anti-inflammatory drugs and gastroprotective agents. These findings warrant the consideration of COX-2 inhibitors as first-line therapy in patients requiring long-term pain control.     

缺血性卒中或短暂性脑缺血发作的双重抗血小板治疗

2013年美国心脏协会/美国卒中协会颁布的缺血性卒中早期处理指南推荐单用阿司匹林进行抗血小板治疗,并未推荐其他抗血小板药,更未推荐联合应用多种抗血小板药.然而,2013年之后发表的大量文献显示,双重抗血小板药在防治缺血性卒中和短暂性脑缺血发作方面优于单个抗血小板药,并评估了双重抗血小板药治疗的安全性.     

氯吡格雷，低分子肝素与阿斯匹林联用治疗急性非ST段抬高心肌梗死的临床观察

目的：探讨氯吡格雷，低分子肝素与阿斯匹林联用治疗急性非ST段抬高心肌梗死（NSTHI）的临床疗效及安全性。方法：选取诊断明确的NSTMI患者36例，分为治疗组和对照组，观察治疗前后ST段变化及心血管原因死亡和心力衰竭的发生情况。结果：与对照组相比，治疗组患者心电图各导联ST段压低情况明显改善，明显降低心力衰竭的发生率。治疗前后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及血小板计数（PLT）无统计学差异。结论：氯吡格雷，低分子肝素与阿斯匹林联用治疗NSTMI疗效优于低分子肝素加阿斯匹林且不增加出血等副作用。     

102例阿司匹林性哮喘病例分析

目的 分析阿司匹林性哮喘(AIA)的临床特点，提高对AIA的认识程度。方法 采用回顾性分析的方法，对诱发AIA的药物及AIA的临床特征进行综合分析。结果 102名AIA患者中，中、重症者83例(81．37％)；56例(54．90％)合并鼻息肉，84例(82．35％)合并鼻窦炎；诱发阿司匹林性哮喘的药物均为COX2／COX1比值较大的环氧化酶(COX)抑制剂。结论 既往有鼻炎和哮喘史，尤其合并副鼻窦炎和鼻息肉者，应警惕AIA的可能，此类患者在应用COX抑制剂时，应尽可能选用选择性COX2抑制剂。     

脑血栓患者阿司匹林联合他汀类药物对颈动脉斑块的影响分析

目的探究脑血栓患者阿司匹林联合他汀类药物对颈动脉斑块的影响。方法资料随机选自2011年12月—2013年12月在本院诊治的脑血栓患者84例,按照随机数字表方法分成两组,每组42例,予以阿司匹林作对照组,予以阿司匹林联合他汀类药物作研究组,分析两组临床疗效、神经功能评分和颈动脉斑块的面积情况。结果研究组有效率95.24%,比对照组78.57%高,比较具统计学上的意义（P〈0.05）;且两组神经功能的缺损评分与颈动脉的斑块面积,均比治疗前低,比较差异明显具统计学上的意义（P〈0.05）;同时研究组神经功能的缺损评分与颈动脉的斑块面积,均比对照组低,比较差异明显具统计学上的意义（P〈0.05）。结论对脑血栓予阿司匹林联合他汀类药物,疗效显著,且颈动脉斑块改善明显,具有一定临床应用和研究价值。     

Aspirin Enhances the Protective Effect of Progesterone on Trophoblast Cell from Oxidative Stress and Apoptosis

Objective::Clinically, low-dose aspirin and progesterone are frequently used to prevent pregnancy loss. We investigated the effect of these drugs on the biologi...