优化阿司匹林使用 平衡获益和风险

Optimization of the use of aspirin: Balance between benefits and risks

阿司匹林可显著降低心血管事件,而在一级预防中需评估获益风险,中危到高危患者在评估出血风险后应该给予阿司匹林,肿瘤获益可能增加了一级预防的净获益。阿司匹林引起的颅内出血和消化道出血呈剂量依赖性,但总体致命性出血无显著增加,出血的防治应该以预防为主,对于消化道损伤高危人群应该给予筛查并预防性使用胃肠道黏膜保护药物。

Aspirin can significantly reduce the cardiovascular events. For the primary prevention, most of the evidence suggested that medium- to high-risk patients should be given low-dose aspirin after the risk of bleeding is assessed. The prevention of cancer may increase the net clinical benefit regarding the total mortality. The intracranial hemorrhage and gastrointestinal bleeding associated with aspirin are dose-dependently increased, but fatal bleeding is not significantly increased as compared with placebo. For the prevention of gastrointestinal injury, high-risk patients should be screened for Helicobaetor pylori and considered undergoing prophylactic treatment with proton pump inhibitor.