阿司匹林对高血压患者心血管疾病一级预防作用的Meta分析

目的 评价阿司匹林对高血压患者心血管疾病一级预防的作用与风险。方法 计算机网络检索PubMed、Web of Science、Cochrane Library、维普数据库、中国知网、万方数据库、中国生物医学数据库中关于阿司匹林用于高血压患者心血管事件一级预防的相关研究,检索时间范围为建库至2019年9月,提取文献数据、检验发表偏倚后,使用STATA 12.0软件进行Meta分析。结果 阿司匹林用于高血压患者心血管疾病一级预防中能够降低多种心血管事件的发生风险（RR=0.93,95%CI:0.90~0.97,P＜0.001）;亚组分析显示,作为一级预防,阿司匹林主要降低非致命性心血管事件的发生风险;对于致死性心血管事件,阿司匹林并没有预防作用;口服阿司匹林组相较于安慰剂组增加了出血风险（RR=1.30,95%CI:1.20~1.40,P＜0.001）。结论 阿司匹林用于高血压患者心血管事件的一级预防确实能够降低非致命性心血管事件的发生风险,但阿司匹林在发挥该作用的同时会诱发出血风险。     

全膝关节置换术后静脉血栓栓塞的预防研究

静脉血栓栓塞症（VTE）是全膝关节置换术后发生和死亡的主要原因。研究显示,术后发生静脉血栓栓塞症可延长住院时间。在过去15年中,尽管临床上采用了全面的静脉血栓栓塞预防方案,但全膝关节置换术后出现肺栓塞的发生率基本保持不变,约为0.4%。目前VTE预防方案包括早期下地行走、患者评估和药物治疗等。对于具有静脉血栓栓塞症风险的患者,阿司匹林应用越来越广泛。最新研究证实,阿司匹林具有相对较低的出血风险和低成本效益。也有研究认为,新型口服抗凝剂、华法林、低分子肝素,包括Xa因子和直接凝血酶抑制剂均对降低术后VTE有效,但可能与出血和伤口并发症发生率的增加有关。本文主要综述近年来VTE预防的研究进展,旨在为临床医生提供用药指导。     

阿司匹林可能增加乳癌患者的存活

据美国WedMD大众医疗新闻网(2010-02-17)报道,规律使用阿司匹林或许可以增加乳癌患者的存活,使用阿司匹林与降低远程复发、乳癌死亡、任何原因死亡等风险有关。     

1例PCI术后盐酸替罗非班诱导的极重度血小板减少的护理

目的 探讨冠状动脉介入术后患者盐酸替罗非班诱发的极重度血小板减少症的临床特点及护理情况,为替罗非班诱导的血小板减少症患者护理提供临床参考。方法 2017年11月我院收治1例急性冠状动脉综合征患者,PCI术后应用盐酸替罗非班致极重度GIT的临床资料及护理情况进行报告。结果 患者PCI术前血小板计数正常,术后应用盐酸替罗非班6 h后出现全身多处瘀斑,血小板计数严重下降至0×109/L,立即停用替罗非班、阿司匹林、氯吡咯雷,并输注血小板、冷冻血浆及使用糖皮质激素治疗,做好防出血护理、用药护理、生活护理、心理干预,血小板计数逐渐升高,约84 h恢复正常。结论 PCI患者应用盐酸替罗非班有诱导的GIT发生风险,积极监测患者血小板变化,加强防出血护理及心理干预,能促进病情恢复。     

胆囊切除围手术期出血与肝功能损害的关系

目的:分析肝功能损害对胆囊切除围手术期出血的影响.方法:通过对23例胆囊切除围手术期出血的病例按其肝功能情况进行分组分析并进行统计处理.结果:轻度的肝功能损害不是引起胆囊切除围手术期出血的主要因素,而当肝硬化、肝功能C级时期危险性显著增加.P＜0.05.结论:胆囊切除围手术期出血主要与手术操作有关,而当肝硬化、肝功能C级时出血风险显著增加,应避免急诊手术.     

PGE2水平在消化道出血患者胃黏膜损伤中的临床表达意义

目的：探讨前列腺素E2(PGE2)在消化道出血患者胃黏膜损伤中的临床表达意义。方法从本院2012年5月~2013年5月收治的消化道出血患者中随机选择50例进行研究，设为观察组。并从同期本院收治的使用阿司匹林但未出现消化道出血的患者随机选择50例设为对照组。检测两组的前列腺素E2(PGE2)水平，并进行比较。结果治疗前，观察组患者的幽门螺杆菌(HP)感染率显著低于对照组(P<0.05)；但前列腺素E2(PGE2)水平和对照组比较差异无统计学意义(P>0.05)。2个月后复查，观察组的前列腺素E2(PGE2)水平较之对照组出现显著的下降(P<0.05)，但幽门螺杆菌(HP)感染率较之对照组差异无统计学意义(P>0.05)。结论使用阿司匹林导致消化道出血和阿司匹林引发的前列腺素E2(PGE2)水平下降有关，且基础PGE2水平较低的患者出现出血的风险更大。     

抗血小板药物治疗致上消化道出血的临床研究进展

大量循证医学证据证实,抗血小板治疗可预防动脉粥样硬化血栓.然而,随着抗血小板治疗人群基数加大与之相关的消化道损伤出血事件也有增多的趋势,因此抗血小板治疗出血风险不容忽视.如何合理评估每个患者的获益和风险,正确选择抗血小板治疗方案,在有效预防消化道损伤的同时,避免可能由抗血小板药物治疗引起的出血事件增加,使更多的心脑血管疾病患者从抗血小板治疗中获益,也成为了临床医生面临的新问题.     

避孕药增加乳腺癌及子宫颈癌风险

<正>据美国国家科学院学报(PNAS)网站(2012-03-12)报道,根据最近一项南非研究显示,口服型及注射型的荷尔蒙避孕药将会增加患乳腺癌与子宫颈癌的风险,但癌症风险会在妇女停用避孕药10年后不再升高,且停用时间愈长风险下降幅度愈大。研究检视南非约翰内斯堡癌症个案控制研究的黑人女性数据,一共找出5 702笔包括乳腺癌、子宫颈癌、子宫内膜癌、卵巢癌及其它非妇癌相关之癌症病例。研究中所指口服型避孕药为合成雌激素与黄体素类型、注射型避孕药则为单独黄体素     

氯吡格雷联合阿司匹林治疗急性冠脉综合征疗效与 安全性的Meta分析

目的 系统评价氯吡格雷联合阿司匹林治疗急性冠脉综合征的疗效。方法 计算机检索英文数据库Embase、Pubmed、The Cochrane Library以及中文数据库CBM、CNKI和WanFang Data,搜集有关氯吡格雷联合阿司匹林治疗急性冠脉综合征的相关临床研究,且研究必须为随机对照试验（RCT）。检索时限从2008年1月~2019年1月。由三位评价员独立筛选文献、提取资料并评价纳入的各项临床研究之间的偏移风险[Tau2=0.00;Chi2=3.35;df=10（P=0.97）;I2=0]后,运用RevMan 5.3软件进行Meta分析。结果 最终纳入11项临床研究,包括2518名患者。Meta分析结果显示:与单用阿司匹林相比,氯吡格雷联合阿司匹林能明显提高治疗的有效率[OR=3.12,95%CI（2.20,4.42）,P<0.00001],其中部分研究报道了氯吡格雷联合 阿司匹林治疗急性冠脉综合征的同时,肌钙蛋白的含量出现了降低[OR=4.94,95%CI（1.77,13.79）,P=0.002];对报道中的不良反应（包括心血管事件的发生、血小板的降低、出血等）进行分析,差异无统计学意义（P＞0.05）。结论 氯吡格雷联合阿司匹林能提高对患有急性冠脉综合征的患者的疗效,并且可能不增加不良反应的发生率。由于受纳入的临床研究质量的限制,上述结论还需通过更多的质量更高的研究予以验证。     

阿司匹林可能预防成人新发哮喘

美国Brighanl妇产医院的Tobias Kurth博士及其同事在1月的《美国呼吸和重症医学杂志》（Am J Respir Crit Care Med．2007；175：120—125.）上报告，经常使用阿司匹林可使成人新发哮喘的风险降低22％。但是，没有证据显示阿司匹林可改善已患哮喘受试者的症状，并且可能引起阿司匹林不耐受哮喘患者急性支气管痉挛。     

持续阿司匹林抗凝对髋膝关节置换出血量的影响

背景：进行髋膝置换前使用阿司匹林抗凝预防心脑血管疾患的患者很多见,而目前国内尚无髋膝关节置换患者围置换期持续应用阿司匹林对于出血量影响的报道。 目的：观察围置换期持续应用小剂量阿司匹林抗凝对于髋膝关节置换出血的影响。 方法：天津市第一中心医院骨科2012年12月至2013年8月收治初次髋膝关节置换患者40例,根据抗凝方案分为两组,每组20例。观察组置换前长期连续规律应用100 mg/d阿司匹林抗凝,除置换日之外不停药。对照组未使用阿司匹林抗凝,与观察组患者年龄相近,与观察组为同一手术医师。两组中全髋关节置换10例,全膝关节置换10例。置换过程中积极止血,置换后采用加压冰敷等减少出血措施。记录置换后48 h伤口引流量、围置换期血红蛋白变化及并发症发生率,随访3个月观察关节功能恢复情况。 结果与结论：两组之间置换前及置换后的血红蛋白变化水平、置换后48 h伤口引流量、围手术期血红蛋白变化、并发症发生率以及随访3个月的关节功能评分差异均无显著性意义。提示积极采取减少出血的措施,围置换期持续应用小剂量阿司匹林抗凝对于初次髋膝关节置换出血无明显影响,可以安全使用。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

氨甲环酸联合不同抗凝药对全膝关节置换术围手术期失血量的影响

目的 探讨氨甲环酸与不同抗凝药联用对全膝关节置换术围手术期失血量的影响。 方法 纳入2014年10月至2019年10月初次行全膝关节置换术并符合标准的158例膝骨性关节炎患者,按氨甲环酸注射方法及术后使用抗凝药分为4组：A组,术中静脉注射氨甲环酸＋术后利伐沙班抗凝;B组,术中静脉注射氨甲环酸＋术后依诺肝素抗凝;C组,术中静脉＋局部注射氨甲环酸＋术后利伐沙班抗凝;D组,术中静脉＋局部注射氨甲环酸＋术后依诺肝素抗凝。各组患者一般情况、术前准备、手术方式及术后处理一致,比较其失血量、凝血功能、输血及围手术期不良事件的发生率。 结果 联合使用氨甲环酸的患者能有效控制总出血量、显性出血量、输血率及血浆D二聚体;术后使用利伐沙班或依诺肝素抗凝,出血量、输血率及围手术期不良事件发生率相当。 结论 TKA术中应用氨甲环酸静脉＋局部注射能有效减少围手术期的失血量、输血率及血浆D二聚体;术后使用利伐沙班或依诺肝素进行抗凝,两者对失血量及围手术期不良事件发生率的影响无明显差异。     

Effect of low-dose aspirin on the international normalized ratio variability in patients with mechanical heart valve prostheses

An increased risk of bleeding is associated with a more intense oral anticoagulation, a greater international normalized ratio (INR) variability and the use of aspirin. We studied the INR variability of patients (n = 121) with modern heart valves who had been prospectively randomized to receive acenocoumarol at a targeted INR of 2.4-3.6 plus aspirin 100 mg/day or acenocoumarol alone at the same dosage, to evaluate whether aspirin influences variability and thus the risk of bleeding. Variability was similar in patients with no events regardless of the use of aspirin. A statistically significantly higher variability was observed in patients with bleeding events independently of the use of aspirin. Nevertheless, the concomitant use of aspirin in patients with a high variability should be monitored closely and thoroughly.     

Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen

BACKGROUND: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. METHODS: We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. RESULTS: We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). CONCLUSIONS: Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs.     

Safety and effectiveness of low dosing of double antiplatelet therapy during long-term left ventricular support with the INCOR system

Adverse events due to anticoagulation and antiplatelet therapy during left ventricular assistance device (LVAD) support are very common, and every effort must be made to reduce their impact. We report our experience using a low dose of double antiplatelet therapy for patients provided with the INCOR LVAD system as a bridge to transplantation. Twelve patients (10 males, 35–60 years old) with acute or end-stage heart failure were included in this study. The mean follow-up was 10 months (cumulative 4.9 years). For antiplatelet therapy, we use an association of variable doses of aspirin and clopidogrel. The use of a platelet aggregation test (PAT) allows reducing the dose of the drugs to the minimum needed. The primary end point was to check the safety of the therapy, analyzing the incidence of major and minor bleeding complications. The secondary end point was to check the effectiveness of the therapy, evaluating the incidence of major and minor thromboembolic events. We had three (25%) cases of early postoperative mediastinal bleeding. On the contrary, no episodes of major bleeding occurred during the follow-up period. The rate of minor bleeding complications was low: 0.2 events per patient/year. The rate of major and minor thromboembolic events was acceptable (respectively 0.09 and 0.2 per patient/year). During LVAD support, double antiplatelet therapy with a low dose of aspirin and clopidogrel was safe and effective. PAT allows reducing the dose of antiplatelet drugs, avoiding complications related to excessive or insufficient dose administration.     

An audit of fresh frozen plasma usage in a tertiary referral centre in a developing country

This paper evaluates the practice of fresh frozen plasma (FFP) transfusion at the University Hospital, Kuala Lumpur, and analyses its usage by the various clinical departments. The aim of this study is to identify where it is inappropriately used and the clinical indications in which such misuse is common. A retrospective analysis of the blood bank request forms and work sheets during a 6-month period between January 1998 and June 1998 formed the basis of this study. Overall, 40% of 2665 units transfused were considered appropriate. However, out of the 931 episodes of FFP transfusions only 31% were for appropriate indications. The average FFP requirement when used for appropriate indication was about 4 units per episode, whereas for inappropriate indication it was 2.5 units per episode. Inappropriate use in terms of the number of units was highest by the surgical services (68%) and Orthopaedics (64%), while the Department of Paediatrics had the lowest incidence of inappropriate use (40%). When Paediatrics was used as the benchmark, the incidence of inappropriate use by other departments was significantly higher (p < 0.01). As for FFP usage in common clinical indications, there was a high incidence of inappropriate use in burns (82%), perioperative period (73%), cardiac surgery (68%), massive bleeding (62%) and trauma (60%). The findings in this study, specifically the use of FFP for volume support in trauma, massive bleeding and burns, routine requests without identified indication in cardiac bypass surgery, and prophylactic use in the perioperative period can be the basis for recommendations to minimize the inappropriate use of FFP in the future.     

Nitrovasodilators, low-dose aspirin, other nonsteroidal antiinflammatory drugs, and the risk of upper gastrointestinal bleeding

BACKGROUND The relation between medications that release nitric oxide, such as nitroglycerin and other nitrovasodilators, and upper gastrointestinal bleeding is uncertain. In animals, these medications reduce the gastric damage induced by nonsteroidal antiinflammatory drugs. Nitric oxide, however, inhibits platelet aggregation and may contribute to bleeding from an ulcer. METHODS: We performed a case-control study to determine the risk of bleeding in patients taking nitrovasodilators, low-dose aspirin, or other nonsteroidal antiinflammatory drugs. The case group was made up of 1122 consecutive patients admitted to one of four hospitals with bleeding from a peptic lesion. The 2231 control subjects were 1109 patients hospitalized for other reasons and 1122 outpatients from the same geographic area. RESULTS: In the week before admission, 520 (46.3 percent) of the patients with bleeding had taken a nonsteroidal antiinflammatory drug other than low-dose aspirin, 120 (10.7 percent) had taken low-dose aspirin (< or = 300 mg per day), 60 (5.3 percent) a nitrovasodilator, and 135 (12.0 percent) an antisecretory agent such as a histamine H2-receptor antagonist or a proton-pump inhibitor. In multivariate models that adjusted for age, sex, and clinical risk factors, the use of a nonsteroidal antiinflammatory drug other than low-dose aspirin was independently associated with an increased risk of bleeding from a peptic ulcer (odds ratio, 7.4; 95 percent confidence interval, 4.5 to 12.0), as was the use of low-dose aspirin alone (odds ratio, 2.4; 95 percent confidence interval, 1.8 to 3.3). The use of a nitrovasodilator was associated with a decreased risk of bleeding (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.9), as was antisecretory therapy (odds ratio, 0.6; 95 percent confidence interval, 0.4 to 0.8). In patients taking any type of nonsteroidai antiinflammatory drug, the use of a nitrovasodilator or antisecretory therapy was independently associated with a decreased risk of bleeding. CONCLUSIONS: The use of nitrovasodilator drugs is independently associated with a decreased risk of upper gastrointestinal bleeding.     

Aspirin and gastrointestinal bleeding.

There is no other over-the-counter (OTC) drug having the widespread use of aspirin. Evoking the well-established analgesic, antipyretic, and anti-inflammatory activities with an amazingly low degree of toxicity, its use has increased in this country to the astounding figure of more than 20 tons daily. The observation that comparatively small daily doses of aspirin may serve as a means of preventing certain types of cardiovascular disasters may lead to even more widespread use of the drug. The most frequent untoward side effect of aspirin is gastric discomfort with or without microbleeding. The amount of bleeding is usually quite small but owing to the long interest of the author in buffered aspirin, it is prudent to determine whether or not this action of aspirin is serious.     

妇产科围手术期抗菌药物使用的合理性评价

目的调查本院妇产科围手术期抗菌药物的使用情况,为促进临床合理使用抗菌药物提供参考。方法抽取2010年1-12月妇产科手术病例316例,记录相关内容,根据《抗菌药物临床应用指导原则》、药品说明书及《应用抗菌药物防治外科感染的指导意见》等相关资料,对妇产科围手术抗菌药物的使用进行合理性评价。结果被调查的病例均使用了抗菌药物,共4大类9个品种。药物选择合理率为64.3%,在术前0.5～2h预防给药的有66例（20.9%）,术后用药疗程大于3d者有120例（38%）,抗菌药物的使用费用所占比例普遍过高。结论本院妇产科围手术期抗菌药物在药物使用率、品种选择、用药时间、药品费用所占比例等方面有待进一步进行干预管理。     

Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery

We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass （OPCAB） surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group （30 patients） received mono-antiplatelet treatment （MAPT） with aspirin 100 mg daily and the other group received dual anfiplatelet treatment （DAPT） with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid （PLAA） and adenosine diphosphate （ADP） （PLADP） were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given （62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05）. There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.