Wemmelund Holger, Jørgensen Trine M M, Høgh Annette, Behr-Rasmussen Carsten, Johnsen Søren P, Lindholt Jes S
Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
J Vasc Surg. 2017 Mar;65(3):616-625.e4. doi: 10.1016/j.jvs.2016.04.061. Epub 2016 Jul 25.
The use of low-dose aspirin (acetylsalicylic acid [ASA]) has been suggested to attenuate growth of abdominal aortic aneurysms (AAAs), yet solid clinical evidence of this hypothesis is still missing. This study aimed to investigate whether preadmission ASA use influenced the risk of presenting with rupture of AAA (rAAA) on hospital admission and subsequent 30-day case fatality.
There were 4010 patients with an incident diagnosis of rAAA and 4010 age- and sex-matched AAA patients identified in the Danish National Registry of Patients. Data on comorbidity, concomitant drug use, primary health care utilization, socioeconomic status, and vital status were obtained from nationwide health care and administrative registries.
Preadmission ASA use was identified for 1815 (45.3%) rAAA patients and 2111 (52.6%) AAA patients, corresponding to a crude odds ratio for rAAA in ASA users of 0.72 (95% confidence interval [CI], 0.66-0.79) compared with nonusers. However, after adjustment for possible confounders, no association between ASA use and the risk of rAAA was found (adjusted odds ratio, 0.97; 95% CI, 0.86-1.08). The aggregated 30-day rAAA case-fatality rate for users of ASA was 66.0% compared with 56.9% for nonusers, corresponding to an adjusted mortality rate ratio of 1.16 (95% CI, 1.06-1.27).
Preadmission ASA use is not associated with an altered risk of AAA rupture but seems to be associated with a worse prognosis after rupture of AAA.
有人提出使用低剂量阿司匹林（乙酰水杨酸[ASA]）可减缓腹主动脉瘤（AAA）的生长，但这一假设仍缺乏确凿的临床证据。本研究旨在调查入院前使用ASA是否会影响入院时AAA破裂（rAAA）的风险以及随后30天的病例死亡率。
在丹麦国家患者登记处确定了4010例初诊为rAAA的患者以及4010例年龄和性别匹配的AAA患者。从全国性医疗保健和行政登记处获取了合并症、伴随用药、初级医疗保健利用情况、社会经济状况和生命状态的数据。
1815例（45.3%）rAAA患者和2111例（52.6%）AAA患者在入院前使用了ASA，与未使用者相比，ASA使用者发生rAAA的粗比值比为0.72（95%置信区间[CI]，0.66 - 0.79）。然而，在对可能的混杂因素进行调整后，未发现ASA使用与rAAA风险之间存在关联（调整后的比值比为0.97；95% CI，0.86 - 1.08）。ASA使用者的30天rAAA病例死亡率总计为66.0%，未使用者为56.9%，对应的调整后死亡率比值为1.16（95% CI，1.06 - 1.27）。
入院前使用ASA与AAA破裂风险的改变无关，但似乎与AAA破裂后的预后较差有关。
