This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Once the elderly take aspirin, can't they stop?What do I need to pay attention to when taking aspirin for a long time?
Aspirin is a cyclooxygenase inhibitor, with strong antiplatelet effect, mainly by making platelet cyclooxygenase acetylation, reducing the synthesis of thromboxane A2, irreversibly inhibiting thromboxane A2-induced platelet aggregation, and can inhibit the platelet aggregation and release reaction caused by low concentration of collagen and thrombin, thereby inhibiting thrombosis, suitable for acute myocardial infarction, acute coronary syndrome, angina, ischemic stroke**, coronary intervention** (balloon dilation, stent implantation), coronary artery bypass grafting (bypass), carotid endarterectomy, prevention of recurrence after myocardial infarction, stroke and transient cerebral ischemia (secondary prevention), prevention of thrombosis in peripheral atherosclerotic diseases, primary prevention of cardiovascular diseases in high-risk groups.
The main role of aspirin is to prevent atherosclerotic thrombosis and reduce the risk of first and recurrent cardiovascular and cerebrovascular events, such as patients with atherosclerotic cardiovascular and cerebrovascular diseases such as angina, myocardial infarction, and stroke, if there are no contraindications, aspirin should be taken for a long time. In addition, there are some people at high risk of cardiovascular and cerebrovascular diseases who need to take aspirin for a long time, such as hypertension with diabetes, hypertension with chronic renal insufficiency, or the risk of cardiovascular events within 10 years as assessed by a doctor to be greater than 20%. Finally, long-term aspirin is recommended for those who meet three or more of the following risk factors:
1.Men over 50 years of age or women postmenopausal.
2.Hypertension.
3.Family history of early-onset cardiovascular and cerebrovascular disease.
4.Smoker.
When our blood vessels are damaged, the platelets in the blood vessels will gather at the injured site, hugging together to promote hemostasis, so the platelets accumulate in the blood vessels, which will promote atherosclerotic thrombosis and block the blood vessels, resulting in myocardial ischemia and even myocardial infarction and ischemic stroke, and aspirin can continue to inhibit platelet aggregation, so as to achieve the purpose of inhibiting thrombosis.
Long-term use of aspirin requires attention:
1.Gastrointestinal injury: Aspirin can directly stimulate the mucosa of the gastrointestinal tract, destroy the mucosal phospholipid layer barrier, lead to gastric mucosal damage, and can also inhibit prostaglandin synthesis and weaken the protective effect of prostaglandin E on the gastrointestinal mucosa, resulting in gastrointestinal mucosal damage, long-term use can cause nausea, vomiting, abdominal pain, diarrhea, indigestion, and even gastric and duodenal ulcers, bleeding, Perforation and other adverse reactions, the use of aspirin enteric-coated preparations can effectively reduce the direct stimulation of aspirin to the gastrointestinal mucosa, but still cannot overcome the mechanism of action of aspirin inhibition of prostaglandin E synthesis, therefore, in the first 6 months of starting to use aspirin, the maximum combination of omeprazole, rabeprazole and other proton pump inhibitors can protect the gastric mucosa and prevent mucosal damage, especially in the elderly and people with gastrointestinal diseases.
2.Time of administration: Aspirin enteric-coated preparations should be taken half an hour to 1 hour before meals, which not only reduces the direct irritation of aspirin to the mucosa of the gastrointestinal tract, but also helps aspirin absorption in the intestine.
3.Bleeding: Aspirin inhibits platelet aggregation, long-term use can increase the risk of bleeding, once nosebleeds, gum bleeding, melena, subcutaneous bleeding and other conditions occur during the medication, the drug should be stopped immediately and sought medical attention.
4.Kidney injury: aspirin inhibits the synthesis of prostaglandins, prostaglandins have the effect of dilating renal blood vessels and increasing renal blood flow, aspirin can weaken the protection of prostaglandins to the kidneys, especially in patients with kidney injury, aspirin can aggravate the condition and even induce acute renal failure, therefore, patients with long-term aspirin should regularly monitor renal function.
5.Acute asthma attack: Aspirin can produce allergic mediator leukotrienes during metabolism, induce bronchospasm, leading to bronchial asthma attacks, so people with a history of bronchial asthma should use aspirin with caution.
6.Acute gout attack: Aspirin is mainly excreted through the kidneys, and low-dose aspirin can compete with uric acid for excretion channels, resulting in obstruction of uric acid excretion, causing acute attacks of gout, therefore, patients with gout or hyperuricemia should regularly monitor blood uric acid when taking aspirin for a long time.