Camargo Eduardo G, Gross Jorge Luiz, Weinert Letícia S, Lavinsky Joel, Silveiro Sandra P
Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
Arq Bras Endocrinol Metabol. 2007 Apr;51(3):457-65. doi: 10.1590/s0004-27302007000300015.
Aspirin is recommended as cardiovascular disease prevention in patients with diabetes mellitus. Due to the increased risk of bleeding and because of the hypothesis that there could be a worsening of microvascular complications related to aspirin, there has been observed an important underutilization of the drug. However, it is now known that aspirin is not associated with a deleterious effect on diabetic retinopathy and there is evidence indicating that it also does not affect renal function with usual doses (150 mg/d). On the other hand, higher doses may prove necessary, since recent data suggest that diabetic patients present the so called "aspirin resistance". The mechanisms of this resistance are not yet fully understood, being probably related to an abnormal intrinsic platelet activity. The employment of alternative antiplatelet strategies or the administration of higher aspirin doses (150-300 mg/d) should be better evaluated regarding effective cardiovascular disease prevention in diabetes as well as the possible effects on microvascular complications.
阿司匹林被推荐用于糖尿病患者预防心血管疾病。由于出血风险增加，且基于阿司匹林可能会使微血管并发症恶化的假说，该药物存在明显使用不足的情况。然而，现在已知阿司匹林对糖尿病视网膜病变无有害影响，且有证据表明常规剂量（150毫克/天）的阿司匹林也不影响肾功能。另一方面，可能需要更高剂量，因为最近的数据表明糖尿病患者存在所谓的“阿司匹林抵抗”。这种抵抗的机制尚未完全明确，可能与血小板内在活性异常有关。对于预防糖尿病患者心血管疾病的有效性以及对微血管并发症可能产生的影响，应更好地评估替代抗血小板策略的应用或给予更高剂量阿司匹林（150 - 300毫克/天）的效果。
