Is There a Relationship between the Use of Analgesics and Non-Steroidal Anti-Inflammatory Drugs and Acute Upper Gastrointestinal Bleeding? A Finnish Case-Control Prospective Study

Background: Our object was to study the role of non-steroidal anti-inflammatory drugs (NSAIDs) as a risk factor in upper gastrointestinal bleeding. Methods: Forty-eight patients with acute bleeding due to esophagitis, gastric or duodenal ulcer, or erosions and 156 age- and sex-matched control patients from the same emergency units were interviewed about the history of ulcer disease, smoking and alcohol habits, and use of analgesics or NSAIDs. Results: Twenty-four patients (50%) and 90 controls (57.6%) had no previous upper abdominal symptoms (NS). There were more heavy smokers among patients (n = 9; 18.8%) than controls (n = 7; 4.5%) (p < 0.01). Five patients (10.4%) and one control (0.6%) had taken more than 20 drinks during the week before admission (p < 0.001). Twenty-nine patients (62.5%) and 81 controls (51.9%) had used some analgesics during the week before admission (NS). There was no difference in the duration of the use of analgesics in the patients and controls. Conclusion: The results do not support the concept that NSAIDs are a major factor associated with serious upper gastrointestinal bleeding.     

The mortality reducing effect of aspirin in colorectal cancer patients: Interpreting the evidence

In 1971 the first study appeared that suggested a relationship between aspirin and cancer. Currently publications on the subject of aspirin and cancer are numerous, with both a beneficial effect of aspirin on cancer incidence and a beneficial effect on cancer survival. This review focusses on the relation between the use of aspirin and improved survival in colorectal cancer patients. Various study designs have been used, with the main part being observational studies and post hoc meta-analyses of cancer outcomes in cardiovascular prevention trials. The results of these studies are unambiguously pointing towards an effect of aspirin on colorectal cancer survival, and several randomised controlled trials are currently ongoing. Some clinicians feel that the current evidence is conclusive and that the time has come for aspirin to be prescribed as adjuvant therapy. However, until this review, not much attention has been paid to the specific types of bias associated with these studies. One of these biases is confounding by indication, because aspirin is indicated for patients as secondary prevention for cardiovascular disease. This review aims to provide perspective on these biases and provide tools for the interpretation of the current evidence. Albeit promising, the current evidence is not sufficient to already prescribe aspirin as adjuvant therapy for colorectal cancer.     

Risk Factors for Gastrointestinal Complications in Aspirin Users: Review of Clinical and Experimental Data

This paper reviews recent clinical evidence that suggests that aspirin prophylaxis against cardiac and cerebral vascular ischemia is associated with significant gastrointestinal complications. The clinical and experimental evidence to confirm the role of risk factors of concomitant use of nonsteroidal anti-inflammatory drugs (NSAID), tobacco cigarette smoking, and alcohol consumption are discussed. The limitations of long-term acid suppression treatment for the prevention of these complications are considered. Future experimental studies to guide the clinical approach to develop novel and potentially cost-effective management strategies are discussed.     

Low-dose aspirin in patients recovering from myocardial infarction. Evidence for a selective inhibition of thromboxane-related platelet function

The adequacy, selectivity and long-term persistence of inhibitionin cyclooxygenase-dependent platelet function by a daily low-dose(0.45 mg kg^–1 day^–1) aspirin treatment have beenevaluated in 15 patients after a recent (less than 17 days)acute myocardial infarction. Serum thromboxane (TX) B₂, an indexof platelet TXA₂ production, was decreased by 94–98% (P<0.001)by aspirin, while urinary excretion of 6-keto-prostaglandinF^la, as an index of extraplatelet cyclooxygenase activity, remainedunchanged. Compared to placebo, aspirin induced a persistentincrease in bleeding time (% difference 45.6±21.4, mean± SD) and a decrease in platelet aggregation by ADP,epinephrine, collagen and arachidonic acid. No tendency towardsan attenuation of the effects was apparent for the period ofaspirin administration (4 weeks). Aspirin 0.45 mg kg^–1 day^–1 is adequate and selectivein the long-term inhibition of TX-related platelet functionin patients after acute myocardial infarction. The clinicaleffectiveness of such a regimen remains to be proven in clinicaltrials.     

丁苯酞、阿托伐他汀联合阿司匹林治疗缺血性脑卒中疗效观察

摘 要 目的:观察丁苯酞、阿托伐他汀联合阿司匹林治疗缺血性脑卒中的疗效。方法：72例缺血性脑卒中患者随机分成观察组和对照组各36例,对照组采用阿托伐他汀片与阿司匹林肠溶片治疗,观察组采用丁苯酞软胶囊、阿托伐他汀片与阿司匹林肠溶片联合治疗,均连续治疗30 d。比较两组患者神经功能改善情况、临床疗效和血脂指标变化。结果：治疗后,两组独立活动能力分级均较治疗前有显著改变（P<0.05）,但两组间比较差异无统计学意义（P>0.05）。观察组总有效率为97.22%;对照组总有效率为91.67%,两组比较差异无统计学意义（P>0.05）。治疗后,两组患者TG、TC、LDL水平均下降（P<0.05）,而HDL水平上升（P<0.05）,组间比较差异无统计学意义（P>0.05）。治疗后两组患者NIHSS评分较前显著下降（P<0.05）,但两组间差异无统计学意义（P>0.05）。两组药品不良反应发生率比较,差异无统计学意义（P>0.05）。结论：丁苯酞联合阿托伐他汀与阿司匹林治疗缺血性脑卒中能显著改善患者的NIHSS评分、独立生活能力和血脂水平,总有效率略高于阿托伐他汀与阿司匹林联合治疗,但差异无统计学意义,且不增加药品不良反应,其临床疗效有待进一步深入研究。     

Kawasaki disease with Glucose-6-Phosphate Dehydrogenase deficiency,case report

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children younger than 5 years of age. Coronary artery abnormalities are the most serious complication.Based on the literatures infusion of Intravenous Immunoglobulin of 2 g/kg and a high dose of oral aspirin up to 100 mg/kg/day are the standard treatment for Kawasaki disease in the acute stage, and should be followed by antiplatelet dose of aspirin for thrombocytosis. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is an inherited X-linked hereditary disorder, and aspirin can induce hemolysis in patients with G6PD deficiency. We report a case of a 5 year and 8 month old male with KD and G6PD deficiency.     

阿司匹林对2型糖尿病患者血清可溶性CD40配体水平的影响

目的观察2型糖尿病（T2DM）患者血清可溶性CD40配体（sCD40L）水平的变化，以及阿司匹林（ASP）对其水平的影响。方法T2DM患者55例按是否服用阿司匹林（ASP）分为DM不服用ASP（DMwithoutASP）组24例和DM服用ASP组（DMwithASP）31例，设对照组33例。采用ELISA法测定血清sCD40L水平。结果DM-ASP组较对照组的sCD40L水平升高（2．14±0．74VS1．89±1．07，P〉0．05），DM＋ASP组CD40L较DM组下降（1．19±0．76，P〈0．01），较对照组下降（P〈0．01）。结论DM患者血清sCD40L升高；服用ASP可降低DM患者sCD40L水平。     

阿司匹林联合辛伐他汀防治缺血性脑血管病临床研究

目的：探讨缺血性脑血管病应用阿司匹林联合辛伐他汀治疗的效果,以丰富临床治疗经验。方法：选择2012年6月～2013年6月在我院接收并确诊的缺血性脑血管病患者100例,根据入院治疗顺序随机分为对照组与观察组各50例,对照组通过给予阿司匹林进行治疗,观察组则通过给予阿司匹林以及辛伐他汀同时治疗,治疗后8周,统计两组患者的治疗总有效率,将结果进行对比。一年以后对所有患者进行随访,了解患者的长期病情。结果：治疗后,患者的临床症状均有明显的改善与缓解,观察组治疗的总有效率为84.00%,优于对照组的68.00%,差异显著（P<0.05）;在治疗一年后,对患者进行随访,观察组心肌梗死、短暂性脑缺血发作以及再发性脑梗死等疾病的发生率为16.00%,远远低于对照组的36.00%,差异显著（P<0.05）。结论：缺血性脑血管病应用阿司匹林联合辛伐他汀治疗,具有疗效确切、安全可靠等优点,值得临床推广。     

阿托伐他汀联合阿司匹林治疗下肢动脉粥样硬化研究

目的：观察阿托伐他汀联合阿司匹林治疗下肢动脉粥样硬化的临床效果。方法：选取下肢动脉粥样硬化患者100例随机分为观察组与对照组,每组50例。对照组采用阿司匹林治疗,观察组采用阿托伐他汀联合阿司匹林治疗,连续治疗2个月后观察两组治疗效果。结果：观察组血黏度、血细胞比容、纤维蛋白原等指标均明显低于对照组,差异具有统计学意义（P<0.05）;观察组与对照组治疗有效率分别为92.0%、76.0%,差异具有统计学意义（P<0.05）。结论：阿托伐他汀联合阿司匹林治疗下肢动脉粥样硬化效果明显优于阿司匹林,是临床防治下肢动脉粥样硬化的有效治疗方案。     

阿司匹林联合依达拉奉治疗急性脑梗死临床效果观察

目的：观察阿司匹林联合依达拉奉治疗急性脑梗死的临床疗效。方法将200例急性脑梗死患者随机分观察组和对照组各100例,观察组给予阿司匹林联合依达拉奉治疗,对照组仅给予依达拉奉治疗,比较2组治疗前后神经功能缺损情况评分和临床疗效。结果2组治疗后1周、2周、3周3个时间点的ESS评分均高于入院时,且观察组均高于对照组;观察组治疗后的总有效率为89％高于对照组的73％,差异均有统计学意义（ P＜0.05）。结论阿司匹林联合依达拉奉治疗急性脑梗死能更好地改善患者临床症状、促进缺损神经功能的恢复,提高患者的生活质量。