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1. Why medication is necessary?

Both domestic and imported aspirin can cause fatal stomach bleeding and cerebral hemorrhage. Hundreds of millions of patients are taking small doses of aspirin, which must be administered and should be standardized.

Aspirin medication (paper or verbal):

Enteric tablets should be taken before meals; when there is abdominal discomfort or bleeding in the body, please consult the doctor; pay attention to the change of stool color, when there is bloody stool, or black stool, please consult the doctor; check every 1~3 months Fecal occult blood and blood routine; alcohol is prohibited during medication.

 

2. What is the minimum effective dose of aspirin?

There are 25mg, 50mg, 100mg different specifications of aspirin on the market, and the usage of the instructions varies greatly.

In general, the minimum effective dose of aspirin for the prevention of coronary heart disease is 75 mg / d, and the minimum effective dose for primary prevention of ischemic stroke is 50 mg / d.

 

3. When is the best time, morning or evening?

Platelets were more active in the morning and the high incidence of cardiovascular events was from 6:00 to 12:00.

Enteric or sustained-release aspirin takes 3 to 4 hours to reach the peak of blood. Oral administration of aspirin before bedtime can better inhibit early morning platelet function; if taking medicine every morning, it can not provide the best protection for high-incidence events.

However, no randomized clinical controlled studies have confirmed that taking aspirin before bedtime can reduce cardiovascular events more, and once aspirin is effective, its anti-platelet aggregation is sustained, and it is not necessary to over-emphasize a certain time to take the drug.

 

4. How do I forget to take aspirin occasionally?

About 10% to 15% of new blood platelets are in the body every day, so aspirin should be taken every day to ensure that the new platelet function is inhibited.

Occasionally forgetting to take aspirin, only 15% of the platelets in the body are active, and have little effect on antithrombotic effects. There is no need to double the dose at the next dose, and the adverse effects of overdose of aspirin will increase.

 

5. When do you have high blood pressure, can you take aspirin?

The absolute risk of intracranial hemorrhage caused by aspirin is only 0.03%.

However, long-term use of aspirin in patients with hypertension should be applied after stable blood pressure control (<150/90mmHg) to avoid an increased risk of intracranial hemorrhage.

 

6. Patients with ulcer history, how to take aspirin?

Aspirin is contraindicated in active peptic ulcer; patients with a history of ulcer disease need to be tested and eradicated for H. pylori (Hp).

Patients with a higher risk of bleeding should take a proton pump inhibitor (PPI) such as omeprazole or an H2 receptor antagonist such as famotidine if long-term use of aspirin.

 

7. Does PPI increase the pH value in the stomach, will it affect enteric-coated aspirin?

Aspirin enteric tablets can be dissolved in alkaline intestinal fluid.

PPI significantly increased the pH in the stomach to around 4, still in an acidic environment. Combined use of PPI does not affect the release and safety of enteric-coated aspirin.

Clopidogrel is a prodrug that requires CYP2C19 to be metabolized into an active product to exert an antiplatelet effect. Clopidogrel should be avoided in combination with the CYP2C19 inhibitor omeprazole and esomeprazole.

 

8. Why should we choose antipyretic analgesics carefully?

Ibuprofen and aspirin work together at the COX-1 binding site to produce competitive inhibition, which affects the antiplatelet effect of aspirin and therefore must be separated from aspirin by at least 5 hours.

Acetaminophen had no effect on the antiplatelet effect of aspirin.

 

9. Do you need to stop taking aspirin when having teeth extraction?

Dental surgery, such as simple tooth extraction, does not require withdrawal, especially in patients with a high risk of thrombosis. Complex dental procedures may require withdrawal.

 

10. How to deal with gum bleeding and hemorrhoids?

The bleeding is mild and appropriate local treatment can be performed without interruption of treatment.

If topical treatment allows complete control of bleeding, there is no need to discontinue aspirin. Patients with severe bleeding should stop using aspirin and actively treat the primary disease.

Patients need to seek medical advice in time!

 

11. How to deal with skin spots?

Skin ecchymoses occur during the course of taking aspirin, and urine, fecal occult blood, platelet count, and platelet aggregation should be monitored. At the same time, pay attention to the tendency of other organs to bleed.

If there is no obvious abnormality, continue to use aspirin or discretionary reduction on the basis of close observation of skin bleeding; if thrombocytopenia occurs, consider discontinuing aspirin.

 

12. Does aspirin aggravate gout?

Aspirin (<2g/d) reduces uric acid excretion, increases serum uric acid levels, and increases the risk of gout recurrence.

Patients with hyperuricemia or gout are first treated aggressively for primary disease; aspirin is not contraindicated, but uric acid levels should be monitored.

 

13. Does aspirin increase asthma?

Asthma induced by taking aspirin for a few minutes or hours is called aspirin asthma.

About half of all aspirin asthma patients are accompanied by nasal polyps and sinusitis. Patients with a history of asthma should be individually assessed for the availability of aspirin, and most patients can use aspirin on the basis of mitigation of tracheal spasm.

 

14. What are the preventive effects of aspirin on thrombotic diseases?

Aspirin is an antiplatelet drug mainly used for the prevention and treatment of arterial thromboembolic diseases. Inhibition of venous thromboembolic disease and intracardiac thrombosis is weak.

The majority of atrial fibrillation-related strokes are ischemic stroke/TIA caused by thromboembolism in the atrial or atrial appendage. Anticoagulant drugs such as warfarin or new oral anticoagulants should be preferred.

The benefits of aspirin are not clear in patients with heart failure without coronary heart disease. Heart failure patients with atrial fibrillation, history of embolism, intracardiac thrombosis, etc., should also be given anticoagulant therapy.

 

15. Which patients should use aspirin?

Mainly used for primary prevention of cardiovascular disease and secondary prevention after acute phase stabilization, including:

  • Primary prevention population with intermediate risk factors (10% risk of cardiovascular events in 10 years).
  • Chronic stable angina.
  • After acute coronary syndrome is stabilized (usually 12 months).
  • After coronary intervention (usually 12 months, depending on whether or not implanted stents and species).
  • After coronary artery bypass grafting (CABG).
  • Peripheral arterial disease.
  • Ischemic stroke.
  • Transient ischemic attack (TIA).
  • After bioprosthetic replacement (after 3 months).
  • Percutaneous aortic valve replacement (after 6 months).

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