JAMA:低剂量阿司匹林一级预防,临床实践中怎么做?

2019-07-31 佚名 医咖会

近期,JAMA上发了一篇专家观点,从临床实践的角度讲述“低剂量阿司匹林一级预防”。

近期,JAMA上发了一篇专家观点,从临床实践的角度讲述“低剂量阿司匹林一级预防”。



早期研究表明,阿司匹林可降低首次心血管事件的发生率可高达20%,但2018年发表的3项临床试验(详见下文)表明,阿司匹林导致心血管事件减少的程度仅为中等,但要承担相应的阿司匹林致出血风险。这些试验的本意是澄清早先的疑问,但却引发了持续不断的争议。这些研究给出的建议略有不同,从一级预防谨慎使用阿司匹林到放弃使用阿司匹林。

最近的AHA/ACC预防指南建议,“在心血管疾病一级预防中不应常规使用阿司匹林”,且仅限于在CVD风险高且出血风险低的患者中使用。

这些新发现为审查阿司匹林一级预防提供了新的方向。

·选择潜在益处大于危害的治疗方法。

·从患者的角度出发理解治疗的益处和伤害。

·优先选择需治疗人数(NNT)较小的治疗方案。

·建议从NNT较小的亚组患者中起始治疗。

·使用患者共享决策(SDM),特别是在药物的潜在益处和危害不明确的情况下。

·采取包括药物和非药物策略在内的全面预防措施。

原始出处:Chiang KF1, Shah SJ1, Stafford RS1. A Practical Approach to Low-Dose Aspirin for Primary Prevention. JAMA. 2019 Jun 28.

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    2019-07-31 1209e435m98(暂无昵称)

    学习了

    0

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    2019-07-31 医者仁心5538

    学习了

    0

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