At present, thrombotic diseases in my country are characterized by high incidence, high death, high disability, and high recurrence of , and the total number of people suffering from diseases has reached more than 10 million. Most patients with thrombotic diseases in my country will use single drugs such as warfarin or aspirin under the guidance of a doctor, and in a few cases (such as acute coronary syndrome ) they will be treated with the two.
However, in my country, since patients can purchase aspirin on their own in the pharmacy, warfarin needs a doctor's prescription to obtain it, many patients who use warfarin single treatment see that others use the combination of the two, blindly add aspirin to seek psychological comfort, but they do not know that this operation can easily increase the risk of bleeding!
October 13 of each year is World Thrombosis Day . On this occasion, the editor will share an article published on JAMAAssessment of an Intervention to Reduce Aspirin Prescribering for Patients Receive Warfarin for Anticoagulation" study aims to help clinicians in drug treatment for thrombotic diseases.
References
111. Research background
Aspirin is an anti-platelet aggregation drug. has an irreversible inhibitory effect on platelet aggregation, and it also inhibits the formation of prostacyclin in the endothelial cells of the vascular wall. It is suitable for the primary prevention of coronary artery disease, as well as the treatment of diseases such as unstable angina pectoris, acute myocardial infarction, etc.
warfarin belongs to the anticoagulant drug , and its activity is to exert anticoagulant effects by inhibiting the synthesis of vitamin K-dependent coagulation factors and anticoagulant proteins.
Aspirin combined with warfarin is only suitable for a few diseases that occur after partial acute coronary syndrome and atrial fibrillation after percutaneous coronary intervention.
For most thrombotic diseases other than the above special diseases, the purpose of effective treatment can be achieved under the guidance of a doctor. But in fact, in my country, many patients who use warfarin will blindly add aspirin, , and there is evidence that the effect of the combination of the two may be more harmful than good, and it is easy to increase the risk of bleeding, which is 1.5 to 2 times that of warfarin alone, and there is no significant effect of reducing thrombosis .
2. Research methods
This study was completed on the basis of the Michigan anticoagulant treatment improvement plan. 6738 cases were included in the case of warfarin treatment and self-use of aspirin (no indications for aspirin medication) (Table 1), including 3160 male cases (5% CI 45.7%~48.1%), with an average age of 62.8 years.
Table 1 Case characteristics
This study was conducted from October 1, 2017 to June 30, 2018. During this period, aspirin was stopped by the doctors intervened in cases, setting the 96 months before the intervention to the 24 months before the intervention to the beginning of the intervention as the historical period, and the 24 months before the intervention to the beginning of the intervention was the pre-intervention stage (the doctor recommended that aspirin be discontinued in cases, but it was not mandatory).
Through cohort study, compared the use of aspirin before and after the intervention, as well as the bleeding and thrombosis .
III. Research results
The preliminary analysis of this study was evaluated before and after the intervention, and the secondary analysis was evaluated before and after the 24 months before the intervention (when the aspirin usage rate first began to decline).
study found that in the 24 months before the intervention, the use of aspirin slightly decreased from 29.4% (5%CI 28.9%~29.9%) to 27.1% (5%CI 26.1%~28.0%, P
Figure 1 Aspirin usage before and after intervention
In preliminary analysis, the incidence of severe bleeding events per month was significantly reduced after intervention, and the incidence before intervention was 0.31% (95% CI 0.27%~0.34%), and the incidence after intervention was 0.21% (95% CI 0.27%~0.34%), and the incidence after intervention was 0.21% (95% CI 0.14%~0.28%) (P=0.03), see Figure 2. From before intervention to after intervention, no significant average percentage change in cases of thrombosis events was observed in (0.21% vs.
Figure 2 Comparison of the incidence of severe bleeding events before and after intervention
Figure 3 Comparison of the incidence of thrombosis events before and after intervention
In the secondary analysis, it was found that reduced aspirin use (starting from 24 months before intervention) and decreased incidence of bleeding events (2.3% vs.
.5%, P=0.02), see Figure 4. The incidence of severe bleeding events also decreased (0.31% vs. .25%, P=0.001), while the incidence of thrombosis in did not change significantly (0.20% vs. .23%, P=0.36).
Figure 4 Comparison of bleeding events before and after intervention
4. Discussion
From this study, we can know that patients who are single-use warfarin treatment under the guidance of a doctor do not blindly add aspirin, which can reduce the incidence of bleeding events, while the condition of thrombosis has not increased.
This study highlighted the importance of in aspirin management in patients treated with warfarin . At the same time, in clinical practice, doctors generally believe that most thrombotic diseases do not require the use of aspirin and warfarin combined treatment.
Therefore, even if aspirin is called a "universal magic medicine" and can be purchased at will at will in the pharmacy, patients still need to discuss the benefits and disadvantages of using the medicine with the doctor. Only when the benefits outweigh the disadvantages can the therapeutic effect of the drug be exerted. Blind use of medicine may aggravate the condition!
Translation: Feng Xiwen
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