Abstract: Coronary artery bypass grafting (CABG) has become more and more popular, but how to decrease the thrombotic stenosis of saphenous vein grafts remains a tough problem clinically. Some researchers raised that aspirin resistance (AR) may be one of the most principal causes of graft thrombus and many correlative studies have been reported in recent years．In this article, we reviewed and analyzed the concept and evaluation criterion, incidence rate, mechanisms, clinic significance, and preventing strategy of AR, expecting to deepen the understanding of AR and help to optimize the antiplatelet therapy for postCABG patients with AR.
ObjectiveTo understand the situation of off-label use of aspirin among outpatients in Sun Yatsen Memorial Hospital, so as to provide baseline data for developing off-label drug use policy. MethodsA stratified random sampling method was used to collected prescription data of aspirin among outpatients in 2013. The incidence rates between different types of off-label use of aspirin were determined by chi-square test, and the influence factors of off-label drug use were analyzed by logistic regression model. ResultsA total of 5 023 prescriptions with aspirin were collected and analyzed, with incidence rate of off-label use up to 17.7%. The major category of off-label use was no indication (94.38%). The top 3 no indications were recurrent abortion, infertility and systemic lupus erythematosus. Drug specification, gender, age and prescribed department were the risk factors of off-label use. ConclusionAspirin off-label use is common among outpatients in Sun Yat-sen Memorial Hospital in 2013, especially in obstetrics and gynecology department and assisted reproductive center. The results suggest that more clinical studies about aspirin for reproduction are needed to provide more evidence of drug use, so as to ensure the safety of drug use in special populations and avoid potential medical risk.
ObjectiveTo compare early postoperative outcomes of Chinese patients undergoing off-pump coronary artery bypass grafting (OPCAB) with or without preoperative discontinuation of aspirin. MethodsClinical data of 354 patients who underwent elective OPCAB in Department of Cardiac Surgery, People's Hospital of Peking University from 2011 to 2012 were retrospectively analyzed. There were 132 patients during year 2011 who discontinued aspirin more than 5 days before OPCAB and were defined as a discontinuation group, including 93 males and 39 females with their age of 36-83 (61.70±8.74) years. There were 222 patients during year 2012 who continued aspirin treatment before OPCAB and were defined as an aspirin group, including 162 males and 60 females with their age of 37-82 (63.26±8.94) years. Postoperative chest drainage, incidence of reexploration for bleeding, in-hospital morbidity and mortality were compared between the 2 groups. Serum cardiac troponin I (cTnI) levels during 4-6 hours, 12-18 hours and 24-48 hours after OPCAB were also compared. ResultsPreoperative clinical characters were not statistically different between the 2 groups (P>0.05). Average number of grafts in the discontinuation group was significantly smaller than that in the aspirin group (3.00±0.89 vs. 3.43±0.93, P=0.001). There was no significant difference in postoperative chest drainage (1 063.75±511.50 ml vs. 1 131.35±460.13 ml, P=0.201), incidence of reexploration for bleeding(0 case vs. 1 case, P=1.000), perioperative myocardial infarction(2 cases vs. 1 case, P=0.647), postoperative acute renal failure(4 cases vs. 7 cases, P=1.000), stroke(1 case vs. 4 cases, P=0.726), mechanical ventilation time(41.46±85.50 hours vs. 52.07±143.59 hours, P=0.441), length of ICU stay(81.46±116.90 hours vs. 79.07±136.43 hours, P=0.867), or in-hospital mortality(0.8% vs. 0.9%, P=1.000)between the 2 groups. Serum cTnI levels during 4-6 hours after OPCAB were not statistically different between the 2 groups (P=0.506). Serum cTnI levels during 12-18 hours and 24-48 hours after OPCAB were statistically different between the 2 groups (P=0.002 and P=0.000). The percentages of patients with cTnI level higher than 4.0 ng/ml during 12-18 hours and 24-48 hours after OPCAB in the aspirin group were significantly lower than those in the discontinuation group (5.4% vs. 16.7%, P=0.001;5.9% vs. 17.4%, P=0.000). ConclusionOPCAB without preoperative discontinuation of aspirin does not increase the risk of postoperative bleeding, in-hospital morbidity or mortality, but can decrease postoperative myocardial injury of Chinese patients undergoing OPCAB.
Objective To study hyperthermia induced apoptosis and the effect of aspirin on hyperthermia induced apoptosis in retinoblastoma cells. Methods Retinoblastoma cells (Y79) were divided into two groups:hyperthermia groups,hyperthermia+aspirin (0.18～18mu;g/ml) groups.Heat shock condition:44℃,heat shock time:10,20,30, and 40 minutes respectively.The following events were studied after heat shock by using FAC Scan: ①cell apoptosis; ②heat shock protein 70 (HSP70) expression；③bcl-2 expression. Results Apoptosis was induced by the treatment of hyperthermia (44℃) in Y79 cells in a heat dose dependent fashion.Longer time heating (44℃，40 minutes) induced necrosis rather than apoptosis.Aspirin could rescue Y79 cells from hyperthermia induced apoptosis in a dose dependent manner．HSP70 was induced in Y79 cells after heat shock,it was further enhanced by the treatment of aspirin(＞1.8mu;g/ml).Heat shock itself showed no effect on bcl-2 expression in Y79 cells,aspirin,on the other hand,could enhance bcl-2 expression in a modest level in heat treated Y79 cells. Conclusions Hyperthermia may induce apoptosis in Y79 cells which can be protected by use of aspirin．The enhancement of HSP70 and bcl-2 expression in Y79 cells by the treatment of aspirin in heating condition may be responsible for the protective function. (Chin J Ocul Fundus Dis, 1999, 15: 143-145)
ObjectivesTo systematically review the safety and efficacy of aspirin in primary prevention of cardiovascular diseases.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of aspirin for primary prevention of cardiovascular diseases from inception to November 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 13 RCTs involving 164 225 participants were included. The results of meta-analysis showed that: aspirin reduced the risk of myocardial infarction (RR=0.85, 95%CI 0.75 to 0.97, P=0.01), ischemic stroke (RR=0.86, 95%CI 0.79 to 0.95, P=0.002) and risk of major adverse cardiovascular events (RR=0.90, 95%CI 0.86 to 0.94, P<0.000 1). However, all-cause mortality (RR=0.97, 95%CI 0.93 to 1.02, P=0.22) and cardiovascular mortality (RR=0.93, 95%CI 0.85 to 1.02, P=0.11) were not reduced. Additionally, it increased risk of hemorrhagic stroke (RR=1.29, 95%CI 1.02 to 1.64, P=0.03), major bleeding (RR=1.43, 95%CI 1.31 to 1.56, P<0.000 01) and gastrointestinal bleeding (RR=1.59, 95%CI 1.33 to 1.90, P<0.000 01).ConclusionCurrent evidence shows that aspirin can reduce the incidence of major adverse cardiovascular events and myocardial infarction during primary prevention of cardiovascular disease, while increase the risk of bleeding, especially gastrointestinal bleeding. Therefore, its potential benefits may be offset. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To improve the knowledge of epidemiology, diagnosis and treatment of aspirin induced asthma ( AIA) in China. Methods Thirty-six cases with AIA who were reported in 30 papers in recent 10 years were analyzed retrospectively. Results The drugs which induced AIA in China mainly included acetylsalicylic acid ( aspirin) , ibuprofen ( Fenbid, ibuprofen) , while acetaminophen ( paracetamol,Bufferin, Tylenol ) , phenylpropanoid thiazide ( Piroxicam) , methoxy-naphthalene C acid ( naproxen) ,diclofenac in rare cases. 28. 6% ( 8 /28) of AIA patients were complicated with nasal disease . AIA could occur at all ages, especially for those over 40 years ( 72. 2% , 26 /36) . No significant difference of prevalencein male and female. The onset time of AIA was less than 60min in 71. 4% and gt;120min in 38. 6% . Most patients took the medications by oral ( 83. 3% ,30/36) , but the AIA onset time was not different by different administration route. Conclusions The incidence of AIA increases in recent years because of widely use of NSAIDs. However, no awareness of NSAIDs induced asthma is common in patients and physicians. For asthma patients it must be caution to take antipyretic analgesic anti-inflammatory drugs. If necessary,methoxy-naphthalene C acid ( naproxen) and diclofenac could be better choice.
【摘要】 目的 比较薤白联合阿司匹林或单用阿司匹林防治心脑血管事件的疗效。 方法 2007年1月〖CD3/5〗2009年9月就诊的188例高危患者纳入研究,随机分为实验组(89例)和对照组(99例)。两组均予口服阿司匹林0.1 g,1次/d。实验组同时给予口服薤白0.9 g,3次/d。观察两组患者血管事件的发生率和不良反应的发生情况。 结果 实验组血管总事件发生率为6.7%,对照组为19.2%,两组间差异有统计学意义(Plt;0.05);实验组脑梗死发生率为1.1%,对照组为9.1%,两组间差异有统计学意义(Plt;0.05)。两组短暂性脑缺血、心绞痛、心肌梗死的发生率比较,差异无统计学意义(Pgt;0.05)。两组皮下出血、血尿、黑便、恶心、腹痛等不良反应的发生率比较,差异无统计学意义(Pgt;0.05)。 结论 服用阿司匹林加薤白可显著降低高危患者心脑血管总事件发生率和脑梗死发生率,增加疗效,而不良反应没有显著增加。【Abstract】 Objective Compare the curative effect of cerebrovascular diseases event prevented with llium macrostemon and aspirin or only with aspirin. Methods Divide the outpatient patients into experimental group (89 patients) and control group (99 patients). Use 0.1 g aspirin for two groups with oral administration once per day. The experimental group is used with 0.9 g allium macrostemon with oral administration three times per day. Observe the generation rate and adverse reaction of vascular events in two groups of patients. Results The Total generation rate of vascular events in the experimental group is 6.7% and the control group is 19.2%,the differences were statistically significant (Plt;0.05); the cerebral infarction generation rate in the experimental group is 1.1% and in the control group is 9.1%,the differences were statistically significant (Plt;0.05). There is no significant difference (Pgt;0.05) in TIA, angina pectoris, myocardial infarction generation rate in two groups. There is no significant difference (Pgt;005) in adverse reaction generation rate of subcutaneous hemorrhage, hematuria, melena, nausea, bellyache. Conclusion Taking aspirin with llium macrostemon can significantly decrease total cardiovascular and cerebrovascular events generation rate and cerebral infarction generation rate in high risk patients, improve the curative effect and the adverse reaction has not been significantly increased.
ObjectiveTo compare clinical results of different anticoagulation methods for patients with large left atrium in the early period after mitral valve replacement (MVR) in order to optimize anticoagulation therapy for them. MethodsA total of 144 patients with large left atrium who underwent MVR in Union Hospital of Tongji Medical College from January 2012 to September 2013 were included in this study. There were 76 male and 68 female patients with their age of 36-60 (47.4±7.0) years. All the patients were divided into 2 groups according to different anticoagulation methods after MVR. Group A patients received warfarin anticoagulation since the 2nd postoperative day. Group B patients received warfarin and aspirin (0.1 g daily) since the 2nd postoperative day. Morbidity and mortality during follow-up were compared between the 2 groups. ResultsInternational normalized ratio (INR) was 2.03±0.11 in group A and 2.01±0.11 in group B,and there was no statistical difference between the 2 groups (t=0.804,P>0.05). Twenty patients (13.9%) had hemorrhagic complications. There was no statistical difference in INR between patients with hemorrhagic complications in group A and B (t=0.496,P>0. 05) and there was no statistical difference in hemorrhagic rate between group A and B(P>0. 05). There was no thromboembolic complication in group B,and 9 patients (6.3%) in group A had thromboembolic complications. Three patients (2%) died of intracranial hemorrhage in group A during follow-up. Two patients died in group B,including 1 patient with recurrent pericardial effusion and pericardial tamponade who died 60 days after surgery,and another patient who died of unknown reason during follow-up. ConclusionFor MVR patients with large left atrium,anticoagulation with warfarin and aspirin can significantly decrease the incidence of thromboembolic complications but does not increase the incidence of hemorrhagic complications.
Objective To assess the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of colorectal neoplasia. Methods A systematic review of all relevant randomized controlled trials and quasi-randomized controlled trials of NSAIDs for prevention of colorectal neoplasms was performed by using The Cochrane Collaboration recommended methods. Results Nine trials were included and assessed. There was sufficient evidence for aspirin to prevent the development of colorectal adenomas compared with placebo in three trials of high quality and large sample size with relative risk (RR) 0.81, 95% confidence interval (CI) 0.72 to 0.91 and P=0.000 5 . No adequate evidence supported aspirin in the prevention of development of colorectal cancer (RR 0.97, 95% CI 0.79 to 1.20, P= 0.79). However, there was no evidence to support sulindac and celecoxib curing or preventing colorectal adenomas or familial adenomatous polyposis (RR 0.71, 95% CI 0.49 to 1.03, P= 0.07 and RR 0.90, 95% CI 0.76 to 1.07, P=0.23). No evidence on the dose of NSAIDs was used for prevention of colorectal adenomas at present. No significant difference was seen in the number of adverse events between patients taking NSAIDs and those taking placebo (P=0.9). Conclusions Aspirin may prevent the development of colorectal adenomas and may avoid polypectomy for 1 in every 10 to 18 persons but we don’t know whether aspirin can be substituted for endoscopically removed colorectal polyps. However, the true clinical benefit for prevention of colorectal neoplasia of NSAIDs should be considered.