Aspirin not only has antipyretic and analgesic effects, but also has anti-inflammatory, anti-rheumatic and anti-platelet aggregation effects. As a century-old classic medicine, it has a “big brother” status in the drug treatment of cardiovascular and cerebrovascular diseases. There is still no substitute. For patients who have used aspirin for a long time, there has been controversy about when to stop taking the drug in recent years. Let’s talk with you about the circumstances under which you should stop taking it. Aspirin’s “one brother” status. Aspirin is a representative drug of antiplatelet drugs. It is effective for all patients with acute ischemic cardiovascular events, such as myocardial infarction, unstable angina, ischemic stroke (cerebral infarction), and If there are no contraindications, aspirin should be given as soon as possible. All patients diagnosed with coronary heart disease or ischemic stroke should take aspirin for a long time, 75-150 mg daily, as a secondary prevention (ie pre-clinical prevention). Aspirin was taken orally from the day before coronary stent placement. Aspirin should be taken for a long time after coronary artery transplantation. For people with a 10-year cardiovascular risk greater than 10%, aspirin should be given 75-100 mg per day as primary prevention (ie prevention of etiology). Aspirin plays an irreplaceable and pivotal role in the primary and secondary prevention of acute coronary syndrome, acute myocardial infarction, ischemic stroke, transient ischemic attack, percutaneous coronary intervention and peripheral arterial disease . Aspirin has become the “cornerstone” of primary and secondary prevention of cardiovascular events. In what situations should aspirin be stopped? (1) When aspirin causes an allergic reaction, aspirin can cause bronchospasm and even induce bronchial asthma. It can also cause acute urticaria, angioedema, severe rhinitis, and even shock. In fact, any drug that causes allergic reactions needs to be stopped as soon as possible to avoid irreversible losses. (2) Any cause of hemorrhage of any cause, including hemorrhage caused by aspirin, such as gastrointestinal bleeding, cerebral hemorrhage, visceral hemorrhage, traumatic bleeding, severe hemorrhoids, etc., must stop aspirin immediately. (3) Whether or not to stop aspirin before some major operations should be judged after carefully weighing the risk of thrombosis after the patient is stopped and the risk of bleeding during the perioperative period. Clinical guidelines recommend that aspirin is likely not to increase the risk of bleeding in low-risk surgery, such as tooth extraction, body surface plastic surgery, cataract surgery, dermatology surgery, prostate biopsy, chest tube syndrome surgery, etc. These operations can not be stopped before surgery Aspirin, but it is likely to increase the risk of bleeding in high-risk surgery, such as orthopedic surgery such as hip surgery, heart surgery, etc., it can be stopped 3 to 7 days before the operation. (4) Severe adverse reactions occurred during the period of taking the medicine. During the period of taking aspirin, if aspirin is suspected of causing severe liver and kidney function abnormalities, platelet abnormalities, hemoglobin abnormalities and other serious adverse reactions, it must be stopped immediately. Conclusion In general, aspirin enteric-coated tablets are relatively safe drugs. The benefits outweigh the disadvantages for patients with cardiovascular and cerebrovascular diseases. If there are no obvious adverse reactions, they should be taken for a long time as much as possible. However, if the above situation occurs, the harm is often greater than the benefit, and the drug may often need to be stopped. Of course, everyone’s personal situation is different, and the dosage and methods of taking aspirin are not exactly the same. Whether it is necessary to stop aspirin should be determined by the doctor after assessing the risk of ischemia and bleeding. It is recommended that patients decide whether to stop aspirin under the guidance of the doctor. (Some of the pictures in the article originate from the network and the copyright belongs to the original author. I would like to express my gratitude to the author of the picture. If you find any violation of your copyright, please contact me and I will delete it.)
Cerebral infarction, also known as “stroke”, our people commonly known as “stroke” and “hemipplegia”, is the first cause of death in our country, and the leading cause of adult disability. Stroke includes two major categories of ischemic stroke and hemorrhagic stroke. Among them, acute ischemic stroke accounts for about 60% to 80% of all strokes, which is the most common type of stroke. The timing of the acute phase of stroke is not uniform, generally refers to within 2 weeks after onset. 1. What should I do if I encounter a stroke? 1. Dial 120 immediately compared with patients who go to the hospital for treatment on their own, the best pre-hospital treatment can be obtained through 120 emergency transport, which can reduce stroke complications, sequelae and mortality. 2. Do not take aspirin without authorization. my country’s hemorrhagic stroke accounts for about 20% to 40% of strokes. Taking aspirin or anticoagulant drugs can only aggravate the condition. 3. Do not take antihypertensive drugs without authorization. About 70% of patients with ischemic stroke have a compensatory increase in blood pressure to maintain blood perfusion in the ischemic area. Excessive blood pressure reduction can aggravate the condition by reducing cerebral perfusion. 2. Which of the commonly used medications is better? 1. Capacity expansion For general ischemic stroke patients, capacity expansion is not recommended (level II recommendation, level B evidence). 2. Vasodilation Therapy is not recommended for patients with general ischemic stroke (Class II recommendation, Class B evidence). 3. Other treatments are as follows. 3. Should neuroprotective drugs be used? Edaravone, citicoline, and piracetam: the efficacy and safety of neuroprotective agents need to be further confirmed by more high-quality clinical trials (level I recommendation, level B evidence). 4. Can statin lipid-lowering drugs stop? A small sample trial compared the effects of stopping statins for 3 days or continuing statin therapy after cerebral infarction, suggesting that short-term statin withdrawal in the acute phase is associated with increased mortality or disability at 3 months. Therefore, patients who have taken statins before the onset of ischemic stroke can continue to use statins (level II recommendation, level B evidence). 5. How to choose Chinese medicine injection? Chinese medicine is widely used in my country to treat acute ischemic stroke. A meta-analysis showed that Chinese medicine can improve neurological deficits, but the quality of research is limited, and it is worthwhile to carry out further high-quality research to confirm. Chinese medicine injections in the acute phase can be divided into two categories: drugs for promoting blood circulation and removing blood stasis and collaterals for meridians and meridians for viscera and viscera. 1. Shuxuetong injection—Huoxue Huayu, Tongjing Huoluo Shuxuetong injection, whose main components are leech and earthworm. Promotes blood circulation and removes blood stasis, and promotes meridians and collaterals. It is used in the acute stage of stroke and meridian caused by blood stasis and obstruction. For acute cerebral infarction, see the above syndromes. Usage and dosage: Intravenous infusion, 6ml per day or as directed by the doctor, added to 250-500ml of 5% glucose injection (or 0.9% sodium chloride injection), slowly instilled. Contraindications: Those with a history of allergies and allergic diseases, pregnant women, those without blood stasis syndrome, and those with bleeding tendency are prohibited. 2. Xingnaojing Injection-Cooling blood and promoting blood circulation, rejuvenating and rejuvenating brain. Xingnaojing injection, the main ingredients are musk, gardenia, turmeric and borneol. Clearing away heat and detoxifying, cooling blood and promoting blood circulation, enlightening the brain and awakening the brain, used for acute stage of cerebral embolism and cerebral hemorrhage. Usage and dosage: intramuscular injection, 2-4ml once, 1-2 times a day. Intravenous infusion of 10-20ml once, dilute with 5%-10% glucose injection or 250-500ml of sodium chloride injection, or inhale, or follow the doctor’s advice. Contraindications: There is currently no information on the interaction between Xingnaojing injection and other drugs. Pregnant women are contraindicated because they contain aromatic ingredients. In addition, it should be used immediately after opening to prevent volatilization. 6. Can the injection be mixed with sugar water? About 40% of patients have post-stroke hyperglycemia. A large number of clinical and experimental studies have found that hyperglycemia in the acute phase of stroke is not only related to the infarct volume of brain tissue, but also can aggravate the neurological deficit of patients and increase the rate of death, morbidity and recurrence. During cerebral ischemia, hypoxia in brain cells can cause glucose to shift from aerobic metabolism to anaerobic metabolism, leading to intracellular lactate poisoning. Glucose infusion will provide more glucose for anaerobic metabolism, further aggravating intracellular acidosis. Therefore, blood glucose concentration should be monitored after stroke, and glucose infusion should not be routinely used after ischemic stroke unless there are special indications. Text: Department of Internal Medicine, Sichuan Urology Hospital. Tang Min
& nbsp. 1. The Special Good News Report of Beijing Satellite TV Health Preservation Column: BTV Beijing Satellite TV Channel “Health Preservation Hall” Broadcast time: May 27, 2020 17: 25 & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. & nbsp. Rebroadcast: May 28, 2020 05:03 Theme: Summer to prevent strokes Moderator: Chen Sai & nbsp. Host Assistant: Chi Yongzhi Director: Li Xiaoshuang, etc. Keynote speaker: Wu Zhongchao, a national old and middle-aged man. From this program of Beijing Health Preservation Hall, we should pay attention to the problem of stroke in summer. Stroke, that is, stroke, is a cerebrovascular disease that people talk about. Stroke, the onset population is getting earlier. This disease presents a high incidence of stroke, high mortality, and a high rate of sequelae! People often only pay attention to the prevention of stroke in the severe winter season. In fact, the summer is more likely to be a season of stroke. People’s knowledge about summer stroke is still insufficient. Nowadays, people’s research and clinical observations tend to overlook the summer stroke problem. 3. Some academic researches on the high incidence of stroke in summer At present, there are only some scattered clinical research reports, such as: using the circular distribution method to explore the season and time regularity of stroke onset. Pan Dongxia & nbsp.Chen Lingli & nbsp.Xie Kaili Qiuyue & Pan Yaxing Zhang Yidan Tongxiang City Center for Disease Control and Prevention Abstract: Objective To analyze the seasonal and temporal regularity of stroke occurrence in Tongxiang City, Zhejiang Province by circular distribution method. Methods A total of 10565 patients with ischemic and hemorrhagic stroke in Tongxiang City from 2010 to 2014 were collected through the chronic disease monitoring system of Zhejiang Province. The seasonal and temporal patterns of stroke were analyzed by circular distribution method. Results There were seasonal differences in the incidence of both types of stroke, with ischemic stroke occurring in summer and hemorrhagic stroke occurring in winter. There is no obvious concentration trend in the incidence of ischemic stroke from 2010 to 2013. The total incidence in 2014 and 5 years has an obvious concentration trend, and there is an average angle.The total average angle is 160.949 ° (Z = 7.061, P & lt.0.001), which is equivalent On June 12, on the contrary, hemorrhagic stroke has a significant concentration trend in the total incidence of each year and 5 years from 2010 to 2013, with a 5-year total average angle of 17.708 ° (Z = 44.998, P & lt.0.001), which is equivalent to 1. On March 18, 2014, there was no concentration of hemorrhagic stroke. Conclusion The incidence of stroke in Tongxiang has obvious seasonality. Blood stroke occurs in winter, and ischemic stroke occurs in summer. In the prevention and treatment of stroke, the seasonal characteristics of its onset should be fully considered, and corresponding measures should be taken to reduce stroke. Morbidity and disability rate. The impact of meteorological elements on stroke incidence Abstract: Objective: To analyze the timing and regularity of stroke occurrence under different meteorological conditions, and to explore the effects of various meteorological elements and abnormal weather on stroke incidence. Methods: Collected medical records of patients with acute stroke in the Department of Neurology of the First Hospital of Shanxi Medical University from 2012 to 2014, and recorded 15 basic meteorological data and 10 derived indicators such as daily temperature, air pressure and humidity in the same period. Use the composition ratio to describe the monthly distribution, seasonal differences and annual concentration trends of stroke incidence. Linear correlation and multiple linear regression analysis of the relationship between each meteorological element and stroke incidence. A 1: 1 paired case-control study was used to explore abnormal weather (cold waves, heat waves) ) The impact on the onset of stroke. Results: 1. The study included 2210 patients with stroke. There were 419 cases of cerebral hemorrhage, including 277 men and 142 women. 1791 cases of cerebral infarction, including 1206 men and 585 women. 2. Cerebral hemorrhage is high in winter and spring, and its incidence has two peak months, April and November. Cerebral infarction is high in spring, and the peak month is May. 3. Straight line correlation analysis showed that the incidence of cerebral hemorrhage was positively correlated with daily maximum pressure and daily minimum pressure (r = 0.114, 0.107, P & lt.0.05), and positively correlated with the three-day temperature difference, daily temperature difference, and 7-day temperature difference derived from the meteorological indicators = 0.123, 0.107, 0.092, P & lt.0.05). Cerebral infarction was positively correlated with daily mean air pressure and daily mean wind speed (r = 0.057, 0.062
Why did the stomach bleed suddenly? A 53-year-old patient with massive gastrointestinal bleeding was sent to the ICU after hemostasis by emergency gastroscopy. There was still bleeding. Since the cause was clearly caused by bleeding from gastric ulcers, surgery was considered. However, the patient himself said that he has been taking aspirin for the past two days, which makes it difficult for doctors. Because of the effect of aspirin, the knife edge is not good to stop bleeding, so intervention is used to stop bleeding. Fortunately, after interventional treatment, the bleeding finally stopped. I asked the patient why he was taking aspirin. Are there any underlying diseases? Such as coronary heart disease or cerebral infarction. The patient listened to the neighbor’s words: Aspirin is a “magic medicine”. It should be taken over the age of 40, which can prevent cardiovascular and cerebrovascular diseases. Because the age is old, the blood becomes thick. The patient’s answer let me know that many people have such misunderstandings. Any medicine has an indication. Not all people of all ages should take it. At the same time, even if it is necessary, there are contraindications to change other medicines. This patient didn’t really need aspirin at first. At the same time, he had stomach ulcers and was still a contraindication to aspirin. Finally, he caused gastrointestinal bleeding. What are the main functions of aspirin? 1. Antipyretic and analgesic: The pharmacological effects are mild and reliable, and are used for colds, fever, headache, neuralgia, muscle pain, and dysmenorrhea. 2. Anti-inflammatory and anti-rheumatic: the curative effect for controlling acute rheumatic fever is rapid and sure, and it is the first choice medicine for rheumatoid arthritis, rheumatoid arthritis and rheumatic fever. However, due to the large dose of anti-rheumatic treatment, it is easy to cause gastric ulcer and gastric bleeding. Long-term medication can damage the liver and kidney, but the damage is reversible and can be restored after stopping the medication. 3. Prevent thrombosis and prevent thromboembolic diseases: low-dose aspirin can inhibit platelet aggregation and prevent intravascular thrombosis. Therefore, it can be used as a conventional therapeutic drug for treating cerebral thrombosis and preventing the occurrence of myocardial infarction. This adapted population is relatively large, and is often the most likely to cause the most misreads. Who should take aspirin? There is a misunderstanding. Many people think that people over the age of 45 take aspirin to prevent cardiovascular, cardiovascular and cerebrovascular diseases. Expert consensus on the use of aspirin in our country recommends taking aspirin in the following situations: 1. People with high blood pressure but whose blood pressure is controlled below 150 / 90mmHg, as well as one of the following conditions, aspirin can be used for primary prevention: ①Age over 50 years old ; ② has target organ damage, including moderately increased plasma creatinine; ③ diabetes. 2. Type 2 diabetes patients over 40 years old, combined with the following cardiovascular risk factors: ①Family history of early-onset coronary heart disease (male, immediate relatives 3, 10 years ischemic cardiovascular disease risk> 10% of the population or combined The following three or more risk factors: ① blood lipid disorders, ② smoking, ③ obesity, ④ & gt.50 years old, ⑤ family history of early-onset cardiovascular disease. 4. How is aspirin used in ischemic cerebrovascular disease? ① For no For patients with acute ischemic stroke treated with thrombolysis, aspirin should be used at a dose of 100-300mg / day and adjusted to a secondary prevention long-term dosage of 75-150mg / day after 2-4 weeks of application. ②Acute ischemia treated with thrombolysis Stroke patients should use aspirin 24 hours after thrombolytic therapy at a dose of 100-300 mg / day. ③Patients with cerebral infarction should take small doses of aspirin for a long time unless there are contraindications to aspirin use. So it is not because of age If you want to take aspirin, if there is no corresponding risk factor, you should not eat it at any age. Notes on aspirin cannot be forgotten 1. Cannot be used by patients with ulcers, it is easy to cause massive bleeding. 2 1. Abnormal blood coagulation function can not be used, such as severe liver damage, low prothrombinemia, vitamin K deficiency. 3. The medicine must be stopped for a week before the operation, otherwise it is difficult to stop the bleeding during the operation. 4. Do not use it for asthma patients, which can cause allergies Reaction, even severe asthma attacks. 5. Pregnant women should not take it. It has teratogenic effects in the early stage, delays delivery in the later stage, and has a greater risk of bleeding. 6. Not suitable for drinking, because it can exacerbate gastric mucosal barrier damage, resulting in gastric bleeding. 7 、 Cannot be taken with vitamin B1, it will increase gastrointestinal tract reaction; combined with anticoagulant bicoumarin, easy to cause bleeding; used with hypoglycemic agent D860, easy to cause hypoglycemia; combined with adrenal cortex hormone, easy Induces ulcers; used with methotrexate to enhance its toxicity; used with furosemide, it is easy to cause salicylic acid poisoning.