Chan Kwan-Leung, Tam James, Dumesnil Jean G, Cujec Bibiana, Sanfilippo Anthony J, Jue John, Turek Michele, Robinson Trevor, Williams Kathryn
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Clin Infect Dis. 2008 Jan 1;46(1):37-41. doi: 10.1086/524021.
In a recent clinical trial, aspirin therapy was initiated approximately 34 days after the onset of symptoms but did not reduce the risk of embolism in patients with endocarditis. However, it is possible that aspirin used early in the course of the disease may be beneficial. The purpose of the study is to assess the effect of long-term daily aspirin use on the risk of embolic events in patients with infective endocarditis.
The clinical characteristics and outcomes of patients excluded from the Multi-Centre Aspirin Trial in Infective Endocarditis because of long-term aspirin use (n = 84) were compared with the data for patients randomized to the placebo arm (n = 55). The former patients took aspirin before and during the early stages of infective endocarditis, whereas the latter patients were not exposed to aspirin before and during the entire hospitalization. Logistic modeling was used to assess the effect of long-term aspirin use on embolism and bleeding.
There was a trend toward excess bleeding in long-term aspirin recipients, compared with placebo recipients (P = .065). Logistic modeling revealed that long-term aspirin use may be associated with excess bleeding (unadjusted odds ratio, 2.35 [P = .059]; adjusted odds ratio, 2.08 [P = .118]), but it had no impact on the risk of embolic events in either model.
In patients with endocarditis, long-term daily use of aspirin does not reduce the risk of embolic events but may be associated with a higher risk of bleeding. In the acute phase of endocarditis, aspirin should be used with caution.
在最近的一项临床试验中，阿司匹林治疗在症状出现约34天后开始，但并未降低心内膜炎患者发生栓塞的风险。然而，在疾病早期使用阿司匹林可能有益。本研究的目的是评估长期每日使用阿司匹林对感染性心内膜炎患者发生栓塞事件风险的影响。
将因长期使用阿司匹林而被排除在感染性心内膜炎多中心阿司匹林试验之外的患者（n = 84）的临床特征和结局与随机分配到安慰剂组的患者（n = 55）的数据进行比较。前一组患者在感染性心内膜炎的早期及期间服用阿司匹林，而后一组患者在整个住院期间均未接触阿司匹林。采用逻辑模型评估长期使用阿司匹林对栓塞和出血的影响。
与安慰剂组相比，长期服用阿司匹林的患者有出血过多的趋势（P = .065）。逻辑模型显示，长期使用阿司匹林可能与出血过多有关（未调整的优势比为2.35 [P = .059]；调整后的优势比为2.08 [P = .118]），但在两种模型中，它对栓塞事件的风险均无影响。
在心内膜炎患者中，长期每日使用阿司匹林并不能降低栓塞事件的风险，但可能与较高的出血风险相关。在心内膜炎的急性期，应谨慎使用阿司匹林。
