Alvarez-Sabín J, Calvo G, Morros R
Servicio de Neurología, Hospital General i Universitari Vall d'Hebron, Barcelona, España.
Rev Neurol. 1997 Apr;25(140):541-4.
The value of acetylsalicylic acid (ASS) in the secondary prevention of ischemic stroke is well established. However, the optimum dose of AAS for stroke-threatened patients remains unsettled. This paper reviews the pattern of adverse reactions to AAS and their relationship to the dosage of ASS evaluated.
All the clinical trials in which AAS was used as the sole antiaggregant in the secondary prevention of ischemic stroke were reviewed. The crude odds ratio for the different adverse reactions was calculated using three sub tests: AAS versus placebo; AAS < 330 mg/d versus AAS > 330 mg/d; and each dosage level versus a placebo.
There is an increased risk associated with the use of AAS as compared to a placebo with respect to gastrointestinal bleeding (OR 2.3, IC 95% (1.6-4.1)), peptic ulcer (10.1 (2.5-85.2)), intracerebral hemorrhage (2.2 (1.3-4)) and other hemorrhagic phenomena (2.6 (2-3.3)).
There seems to be a direct relationship between the dosage of AAS and the frequency with which adverse reactions occur, except in the case of intracerebral hemorrhage. In the latter case there was no relationship with the dose given (0.8 (0.5-1.4)).
乙酰水杨酸（ASS）在缺血性中风二级预防中的价值已得到充分证实。然而，对于有中风风险的患者，ASS的最佳剂量仍未确定。本文回顾了ASS不良反应的模式及其与所评估的ASS剂量的关系。
回顾了所有将ASS用作缺血性中风二级预防唯一抗血小板药物的临床试验。使用三个子试验计算不同不良反应的粗比值比：ASS与安慰剂对比；ASS<330mg/d与ASS>330mg/d对比；以及每个剂量水平与安慰剂对比。
与安慰剂相比，使用ASS会增加胃肠道出血（比值比2.3，95%置信区间（1.6 - 4.1））、消化性溃疡（10.1（2.5 - 85.2））、脑出血（2.2（1.3 - 4））和其他出血现象（2.6（2 - 3.3））的风险。
除脑出血外，ASS剂量与不良反应发生频率之间似乎存在直接关系。对于脑出血，其与给药剂量无关（0.8（0.5 - 1.4））。
