Poor awareness of preventing aspirin-induced gastrointestinal injury with combined protective medications

AIM:To investigate prescribing pattern in low-dose aspirin users and physician awareness of preventing aspirin-induced gastrointestinal(GI) injury with combined protective medications.METHODS:A retrospective drug utilization study was conducted in the 2nd Affiliated Hospital,School of Medicine,Zhejiang University.The hospital has 2300 beds and 2.5 million outpatient visits annually.Data mining was performed on all aspirin prescriptions for outpatients and emergency patients admitted in 2011.Concomitant use of proton-pump inhibitors(PPIs),histamine 2-receptor antagonists(H2RA) and mucoprotective drugs(MPs) were analyzed.A defined daily dose(DDD) methodology was applied to each MP.A further investigation was performed in aspirin users on combination use of GI injurious medicines [non-steoid anti-inflammatory drugs(NSAIDs),corticosteroids and clopidogrel and warfarin] or intestinal protective drugs(misoprostol,rebamipide,teprenone and gefarnate).Data of major bleeding episodes were derived from medical records and adverse drug reaction monitoring records.The annual incidence of major GI bleeding due to low-dose aspirin was estimated for outpatients.RESULTS:Prescriptions for aspirin users receiving PPIs,H2RA and MPs(n = 1039) accounted for only 3.46% of total aspirin prescriptions(n = 30 015).The ratios of coadministration of aspirin/PPI,aspirin/H2RA,aspirin/MP and aspirin/PPI/MP to the total aspirin prescriptions were 2.82%,0.12%,0.40% and 0.12%,respectively.No statistically significant difference was observed in age between patients not receiving any GI protective medications and patients receiving PPIs,H2RA or MPs.The combined medication of aspirin and PPI was used more frequently than that of aspirin and MPs(2.82% vs 0.40%,P < 0.05) and aspirin/H2RA(2.82% vs 0.12%,P < 0.05).The values of DDDs of MPs in descending order were as follows:gefarnate,hydrotalcite > teprenone > sucralfate oral suspension > L-glutamine and sodium gualenate granules > rebamipide > sucralfate chewable tablets.The ratio of MP plus aspirin prescriptions to the total MP prescriptions was as follows:rebamipide(0.47%),teprenone(0.91%),L-glutamine and sodium gualenate granules(0.92%),gefarnate(0.31%),hydrotalcite(1.00%) and sucralfate oral suspension(0.13%).Percentages of prescriptions containing aspirin and intestinal protective drugs among the total aspirin prescriptions were:rebamipide(0.010%),PPI/rebamipide(0.027%),teprenone(0.11%),PPI/teprenone(0.037%),gefarnate(0.017%),and PPI/gefarnate(0.013%).No prescriptions were found containing coadministration of aspirin and other NSAIDs.Among the 3196 prescriptions containing aspirin/clopidogrel,3088(96.6%) prescriptions did not contain any GI protective medicines.Of the 389 prescriptions containing aspirin/corticosteroids,236(60.7%) contained no GI protective medicines.None of the prescriptions using aspirin/warfarin(n = 22) contained GI protective medicines.Thirty-five patients were admitted to this hospital in 2011 because of acute hemorrhage of upper digestive tract induced by low-dose aspirin.The annual incidence rates of major GI bleeding were estimated at 0.25% for outpatients taking aspirin and 0.5% for outpatients taking aspirin/warfarin,respectively.CONCLUSION:The prescribing pattern of low-dose aspirin revealed a poor awareness of preventing GI injury with combined protective medications.Actions should be taken to address this issue.

钙剂加阿司匹林综合治疗妊娠期高血压疾病的疗效及机制

目的：探讨钙剂加小剂量肠溶阿司匹林对妊娠期高血压疾病的疗效及可能的机制.方法：妊娠期高血压疾病的孕妇78例分为对照组和实验组各39例,前者仅用硫酸镁常规解痉降压,后者在解痉降压基础上口服多维钙咀嚼片（迪巧）及小剂量肠溶阿司匹林.观察两组母婴结局.平均动脉血压、24h尿蛋白和血清钙水平的改变,以及凝血和血栓前状态分子标志物水平的变化.结果：实验组和对照组胎心异常率依次为7.69%和23.08%,差异具有统计学意义（P〈0.01）.治疗前实验组平均动脉血压为（126.2±15.6）mmHg（1mmHg=0.133kPa）,24h尿蛋白为（3.85±0.47）g和血清钙为（1.83±0.41）mmol/L,治疗后依次为（102.5±16.8）mmHg,（1.56±0.63）g和（2.44±0.35）mmol/L,差异具有统计学意义（P〈0.01～0.05）.实验组治疗前PT,Fbg,TAT和D-dimer检测值依次为（10.92±0.55）s,（5.8±1.3）g/L,（24.5±4.3）mg/L和（1.55±0.46）mg/L,治疗后依次为（11.26±0.82）s,（4.2±0.6）g/L,（9.56±3.7）mg/L和（0.72±0.22）mg/L,差异均具有统计学意义（P〈0.01～0.05）.结论：钙剂加小剂量肠溶阿司匹林治疗妊娠期高血压疾病效果较好,能有效降低平均动脉血压,改善患者孕妇凝血功能和血栓前状态,改善母婴结局.

钙剂加肠溶阿司匹林对妊娠期高血压的疗效观察

目的分析研究对妊娠期高血压疾病中的轻度子痫前期采用钙剂加小剂量肠溶阿司匹林治疗的疗效及应用机制。方法将接受治疗的妊娠期高血压疾病中的轻度子痫前期患者112例随机分成实验组(56例)和对照组(56例),给予对照组患者常规的解痉降压药物治疗,同时在此基础上给予实验组患者钙剂加小剂量肠溶阿司匹林进行治疗。观察比较两组患者经过治疗后的母婴结局、凝血及血栓前状态分子标志物血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、凝血酶2抗凝血酶6复合物(TAT)、D2二聚体(D-dimer)的变化和动脉血压、24小时蛋白尿指标的变化情况。结果对照组患者胎心异常率(26.79%)明显高于实验组患者胎心异常率(1.79%)(x^2=14.2917,P<0.05)。实验组治疗后动脉血压指标的变化程度明显优于对照组(t=6.4076,P<0.05)。与治疗前相比,实验组治疗后PT、Fbg、TAT、APTT和D-dimer水平差异均有统计学意义(t值分别为4.5595、7.9440、3.2263、1.9978、11.6673,均P<0.05)。与治疗前相比,对照组治疗后Fbg、TAT、D-dimer、PT、APTT水平差异亦均有统计学意义(t值分别为3.3004、2.5377、3.0017、2.6192、2.5339,均P<0.05)。两组治疗后PT、Fbg、TAT、APTT和D-dimer比较差异均有统计学意义(t值分别为2.9420、8.5185、3.1422、4.3983、2.6738,均P<0.05)。结论钙剂加小剂量肠溶阿司匹林治疗轻度子痫前期患者的疗效较好,减少了患者的凝血并改善了其血栓前状态。

小剂量拜阿司匹林肠溶片对妊娠期高血压患者24 h尿蛋白定量的影响

目的探讨小剂量拜阿司匹林肠溶片对妊娠期高血压患者24 h尿蛋白定量的影响。方法选择2018年4月至2019年5月220例妊娠期高血压患者,随机分为两组各110例,研究组采用小剂量拜阿司匹林肠溶片治疗,对照组采用大剂量拜阿司匹林肠溶片治疗。两组治疗前后测定舒张压(DBP)与收缩压(SBP)及24 h尿蛋白,记录两组的分娩方式及产后异常出血情况,记录两组胎儿围生期并发症。结果治疗后,两组的SBP水平、DBP水平、24 h尿蛋白、剖宫产率、胎儿围生期并发症发生率比较差异无统计学意义(P> 0.05),但研究组产后异常出血发生率明显低于对照组(P <0.05)。结论小剂量拜阿司匹林肠溶片能够有效降低妊娠期高血压患者的血压及24 h尿蛋白,且可降低产后异常出血风险。