Department of Haematological Medicine, Guy's and St Thomas' Hospitals, London, UK.
Vascular Medicine, King's College Hospital, London, UK; Department of Angiology, University Hospital Basel, Switzerland.
Thromb Res. 2015 Feb;135(2):217-25. doi: 10.1016/j.thromres.2014.11.036. Epub 2014 Dec 13.
Cardiovascular disease (CVD) includes a number of conditions such as myocardial infarction, coronary heart disease, stroke, and venous thromboembolism. CVD is a leading health problem worldwide and a major cause of mortality, morbidity, and disability; it is also associated with high healthcare costs. The incidence of CVD is predicted to increase in the forthcoming years, and thus it is crucial that physicians are aware of the benefits and limitations of the available therapies to ensure patients receive optimized treatment. Current clinical practice guidelines provide recommendations on the use of anticoagulants and antiplatelets for both the prevention and treatment of CVD. Aspirin is the most studied antiplatelet agent in this context. The benefits of aspirin are well documented and supported by data from robust clinical trials for CVD conditions, such as acute coronary syndrome and stroke prevention in patients with atrial fibrillation. However, the clinical benefits of aspirin are less clear for other conditions, namely for primary prevention of venous thromboembolism after major orthopaedic surgery, particularly in comparison with newer drugs such as the direct oral anticoagulants. This article provides an outline of the current guidelines and a critical assessment of the efficacy and safety data supporting the recommendations for the use of aspirin in the treatment and prevention of venous thromboembolism and other cardiovascular disorders.
心血管疾病 (CVD) 包括多种疾病,如心肌梗死、冠心病、中风和静脉血栓栓塞症。CVD 是全球范围内的主要健康问题,也是导致死亡率、发病率和残疾的主要原因;它还与高昂的医疗保健费用有关。预计 CVD 的发病率将在未来几年增加,因此医生必须了解可用治疗方法的益处和局限性,以确保患者接受最佳治疗。目前的临床实践指南提供了关于抗凝剂和抗血小板药物在 CVD 的预防和治疗中的使用建议。阿司匹林是这方面研究最多的抗血小板药物。阿司匹林的益处有充分的证据支持,并且得到了大量临床试验数据的支持,这些临床试验涉及 CVD 相关疾病,如急性冠状动脉综合征和房颤患者的中风预防。然而,阿司匹林在其他疾病中的临床获益则不太明确,例如在大型骨科手术后预防静脉血栓栓塞症,特别是与新型药物如直接口服抗凝剂相比。本文概述了当前的指南,并对支持阿司匹林在治疗和预防静脉血栓栓塞症及其他心血管疾病中应用的疗效和安全性数据进行了批判性评估。