急診小醫師ymmcc的醫學筆記: 12/30/19

2019年12月30日星期一

並非所有人都可以服用阿斯匹靈

參考資料. 梅約診所, 美國最大醫學中心.

Daily aspirin therapy: Understand the benefits and risks

每天服用阿斯匹靈雖然可以救命, 但並非人人如此, 要每日服用阿斯匹靈之前, 你需要知道的事實.
Daily aspirin therapy can be a lifesaving option, but it's not for everyone. Get the facts before considering a daily aspirin.
By Mayo Clinic Staff

每天服用阿斯匹靈雖然可以降低心臟病發作機率, 但並非人人適用.
Daily aspirin therapy may lower your risk of heart attack, but daily aspirin therapy isn't for everyone. Is it right for you?

如果你曾發生過心肌梗塞或中風, 醫師會建議你每天服用阿斯匹靈, 除非發生嚴重過敏或曾經出血. 如果你發生第一次心肌梗塞的危險性很高, 醫師在評估利弊之後可能會建議你服用阿斯匹靈
If you've had a heart attack or stroke, your doctor will likely recommend you take a daily aspirin unless you have a serious allergy or history of bleeding. If you have a high risk of having a first heart attack, your doctor will likely recommend aspirin after weighing the risks and benefits.

不可自行服用阿斯匹靈, 如果因為頭痛, 身體痠痛, 發燒, 偶而服用阿斯匹靈, 對於多數人而言是安全的, 但每天服用阿斯匹靈可能會發生嚴重副作用, 包括內出血.
You shouldn't start daily aspirin therapy on your own, however. While taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding.

阿斯匹靈如何預防心臟病發作?
阿斯匹靈會影響人體的凝血功能, 人們流血時, 血液中的血小板會在傷口凝集, 血小板有助於血塊生成, 封住血管的傷口來止血.
How can aspirin prevent a heart attack?
Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, build up at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.

這些血塊也可能在提供心臟血流的血管(冠狀動脈)內形成, 脂肪在動脈壁會沉積, 形成粥狀斑塊, 如果動脈因粥狀硬化而狹窄, 這些粥狀斑塊表面的脂肪沉積有時候可能會破裂.
But this clotting can also happen within the vessels that supply your heart with blood. If your blood vessels are already narrowed from atherosclerosis — the buildup of fatty deposits in your arteries — a fatty deposit in your vessel lining can burst.

粥狀斑塊破裂之後會很快形成血栓, 阻斷動脈血流, 血液無法流入冠狀動脈, 這就是心臟病發作, 阿斯匹靈可降低血小板凝集, 可預防心臟病發作.
Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart and causes a heart attack. Aspirin therapy reduces the clumping action of platelets — possibly preventing a heart attack.

你應該每天吃阿斯匹靈嗎?
需與醫師討論, 每天服用阿斯匹靈是否可以幫助你避免心臟病發作. 在某些條件, 醫師會建議你每天吃 aspirin.
Should you take a daily aspirin?
Talk with your doctor about whether daily aspirin therapy might help you prevent a heart attack. Your doctor may suggest daily aspirin therapy if:

下列情況建議每天服用阿斯匹靈
曾經心臟病或中風發作
過去不曾心臟病發作, 但冠狀動脈內曾經放置支架, 曾經接受過冠狀動脈繞道手術 CABG. 曾因冠狀動脈疾病引起心絞痛, 雖然這些情況不一定發生過心臟病, 但也屬於心臟病危險因子

You've already had a heart attack or stroke.
You haven't had a heart attack, but you have had a stent placed in a coronary artery, you have had coronary bypass surgery, or you have chest pain due to coronary artery disease (angina).
You've never had a heart attack, but you're at high risk of having one.

糖尿病患, 且至少有一項以上的心臟病危險因子:
抽菸.
高血壓
男性大於 50歲
女性大於60歲
服用阿斯匹靈是要預防心臟病發作,

僅有糖尿病但沒有以上任一項危險因子, 服用阿斯匹靈是否有好處仍有爭議
You have diabetes and at least one other heart disease risk factor — such as smoking or high blood pressure — and you're a man older than 50 or a woman older than 60. The use of aspirin to prevent heart attacks in people with diabetes but no other risk factor is controversial.

美國預防服務工作組建議以下情況考慮每天服用阿斯匹靈
年齡 50-59 歲
-沒有易出血的風險
-未來十年內發生心臟病或中風的機率逐漸增加超過 10%,
年齡 60-69 歲
- 沒有易出血的風險
- 未來十年內發生心臟病或中風的高危險機率超過 10%

The U.S. Preventive Services Task Force recommends daily aspirin therapy if you're age 50 to 59, you're not at increased bleeding risk, and you have an increased risk of heart attack or stroke of 10 percent or greater over the next 10 years. If you're age 60 to 69, you aren't at increased bleeding risk, and you have a high risk of heart attack or stroke of 10 percent or greater over the next 10 years, talk to your doctor about daily aspirin therapy.

50歲以下或70歲以上的人, 服用阿斯匹靈預防心血管疾病和大腸直腸癌的利弊尚需更多研究,
More research is needed to determine the benefits and risks of daily aspirin use in adults younger than age 50 and older than age 70 before a recommendation can be made for or against aspirin use to prevent cardiovascular disease and colorectal cancer for these age groups.

雖然過去在某些特定群體, 雖然沒有心臟病史, 也建議服用阿斯匹靈, 但專家對此仍有不同看法,
Although aspirin has been recommended in the past for certain groups of people without a history of heart attack, there's some disagreement among experts about whether the benefits of aspirin outweigh its potential risks.

未發生心臟病 or 中風 or 其他心血管疾病的人, 美國FDA 不建議防性服用阿斯匹靈預防心臟病發作.
The Food and Drug Administration doesn't recommend aspirin therapy for the prevention of heart attacks in people who haven't already had a heart attack, stroke or another cardiovascular condition.

不同組織會提出不同的指引, 但隨著更多研究報告出現, 這些指引也不斷更新, 對於心臟病低風險的人, 每天服用阿斯匹靈的好處無法抵消出血的缺點.
Guidelines are varied between organizations, but they're evolving as more research is done. The benefits of daily aspirin therapy don't outweigh the risk of bleeding in people with a low risk of heart attacks. The higher your risk of heart attack, the more likely it is that the benefits of daily aspirin outweigh the risk of bleeding.

每天服用阿斯匹靈需與醫師討論
The bottom line is that before taking a daily aspirin you should have a discussion with your doctor.

有哪些其他狀況應該避免服用阿斯匹靈?
在醫師建議你開始服用阿斯匹靈之前, 需告知醫師你的健康狀態, 是否出血或其他併發症的風險增加, 包括以下情況
Should you avoid daily aspirin therapy if you have another health condition?
Before starting daily aspirin therapy under the advice of your doctor, you should let him or her know if you have a health condition that could increase your risk of bleeding or other complications. These conditions include:

服用阿斯匹靈造成出血或其他併發症的危險因子
有凝血功能異常疾病
對阿斯匹靈過敏, 這類患者可能服用之後造成氣喘發作
出血性胃潰瘍
A bleeding or clotting disorder (bleeding easily)
Aspirin allergy, which can include asthma caused by aspirin
Bleeding stomach ulcers

阿斯匹靈建議劑量, 每天 75mg ~ 150 mg, 但多數建議 81mg 就有預防效果. (台灣看到的通常是 100 mg ), 醫師開立的劑量通常是 75mg~325mg

What's the best dose of aspirin to take?
Your doctor will discuss what dose is right for you. Very low doses of aspirin — such as 75 to 150 milligrams (mg), but most commonly 81 mg — can be effective. Your doctor will usually prescribe a daily dose anywhere from 75 mg — the amount in an adult low-dose aspirin — to 325 mg (a regular strength tablet).

如果你曾心臟病發作, 或曾經放過冠狀動脈支架, 服用阿斯匹靈或其他抗凝血藥物相當重要,
If you have had a heart attack or have had a heart stent placed, it's very important to take aspirin and any other blood-thinning medications exactly as recommended.

如果你停止服用阿斯匹靈會怎樣?
停用阿斯匹靈之後可能出現反彈現象, 增加心臟病風險
如果你曾心臟病發, 或有裝冠狀動脈支架, 停用阿斯匹靈可能導致危及生命的心臟病發作
What happens if you stop taking aspirin every day?
You might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack. If you have had a heart attack or a stent placed in one or more of your heart arteries, stopping daily aspirin therapy can lead to a life-threatening heart attack.

如果你正每天服用阿斯匹靈卻想停止, 需與醫師討論. 突然停用阿斯匹靈可能出現反彈效應 , 使血栓容易出現
If you have been taking daily aspirin therapy and want to stop, it's important to talk to your doctor before making any changes. Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot.

如果你經常服用 ibuprofen (一種NSAID止痛消炎藥) 或其他NSAID, 可以服用阿斯匹靈嗎?
aspirin 及其他NSAID, 例如 ibuprofen, naproxen, 會降低血小板的凝血功能, 經常使用 NSAID 會增加出血機率
Can you take aspirin if you regularly take ibuprofen or another nonsteroidal anti-inflammatory drug (NSAID) for another condition?
Both aspirin and nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Motrin IB, Advil, others) and naproxen sodium (Aleve), reduce the clotting action of blood platelets. Regular use of nonsteroidal anti-inflammatory medications can increase your bleeding risk.

有些NSAID 會讓心臟病發作機率增肌. 此外, 有些 NSAID 可能會與 aspirin 產生不良的交互作用, 增加出血風險.
Some NSAIDs can increase the risk of heart attacks on their own. Additionally, some NSAIDs can adversely interact with aspirin, increasing the risk of bleeding even more.

如果你儘服用一次 ibuprofen, 吃完兩小時再吃 aspirin, 如果你需要 ibuprofen 或其他 NSAID, 需與醫師討論不會干擾阿斯匹靈的替代藥物.
If you need only a single dose of ibuprofen, take it two hours after the aspirin. If you need to take ibuprofen or other NSAIDs more often, talk to your doctor about medication alternatives that won't interfere with daily aspirin therapy.

服用阿斯匹靈的副作用如下
What are the possible side effects of daily aspirin therapy?
Side effects and complications of taking aspirin include:

有些中風是血管破裂造成, 阿斯匹靈可以預防血栓相關的中風, 但會增加出血性中風機率
腸胃道出血, 每天服用阿斯匹靈會增加罹患胃潰瘍機率. 如果有出血性潰瘍, 或其他腸胃道部位出血, 服用阿斯匹靈會讓出血更嚴重. 甚至可能危及生命
過敏反應. 如果對阿斯匹靈過敏. 服用任何劑量都可能誘發嚴重過敏反應
如果近期要手術或牙齒治療, 需告知手術醫師或牙醫, 你服用的阿斯匹靈劑量, 否則手術中可能造成出血過多. 停用阿斯匹靈之前需與醫師討論
Stroke caused by a burst blood vessel. While daily aspirin can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke).
Gastrointestinal bleeding. Daily aspirin use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer or bleeding anywhere else in your gastrointestinal tract, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent.
Allergic reaction. If you're allergic to aspirin, taking any amount of aspirin can trigger a serious allergic reaction.
If you're taking aspirin and need a surgical procedure or dental work, be sure to tell the surgeon or dentist that you take daily aspirin and how much. Otherwise you risk excessive bleeding during surgery. Don't stop taking aspirin without talking to your doctor, however.

常規服用阿斯匹靈且飲酒的人, 胃出血機率會增加, 需與醫師討論每天多少酒精是安全的. 對於一般健康成人, 女性或65歲以上男性, 適當的飲酒量是指每天一杯啤酒. 對於 65 歲以下健康年輕男性, 每天可喝兩杯
People who regularly take aspirin and drink alcohol can have an increased risk of stomach bleeding. Talk to your doctor about how much alcohol is safe to drink. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

會與阿斯匹靈交互作用的藥物
What are possible drug interactions with daily aspirin therapy?
If you're already taking an anticoagulant, such as warfarin (Coumadin, Jantoven), apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto) for another condition, combining it with aspirin may greatly increase the risk of major bleeding complications. However, there may be some conditions for which combining a low dose of aspirin with warfarin or another anticoagulant is appropriate. But, this therapy always needs to be carefully discussed with your doctor.

其他藥物或草藥也可能增加出血機率. 包括下列
Other medications and herbal supplements also may increase your risk of bleeding. Medications that can interact with aspirin include:
Heparin
Ibuprofen (Advil, Motrin IB, others), when taken regularly
Corticosteroids
Clopidogrel (Plavix)
Some antidepressants (clomipramine, paroxetine, others)

有些每天吃的保健食品可能會增加出血機率, 如下
Taking some dietary supplements can also increase your bleeding risk. These include:
Bilberry
Capsaicin
Cat's claw
Danshen
Evening primrose oil
Ginkgo
Kava
Ma-Huang
Omega-3 fatty acids (fish oil)

如果你每天服用阿斯匹靈, 在心臟病發作時服用阿斯匹靈安全嗎?
這時候應該去醫院, 可以打電話叫救護車, 不要耽誤時間, 僅吃阿斯匹靈無法救命
If you take daily aspirin, is it still safe to take an aspirin during a heart attack?
If you think you're having a heart attack, the most important thing for you to do is call 911 or emergency medical services. Don't delay calling for help. Aspirin alone won't save your life if you're having a heart attack.

The operator may advise you to chew an aspirin, but will first ask questions to make sure you're not allergic to aspirin or you don't have any other health conditions that would make taking an aspirin during a heart attack too risky. It's OK to chew an aspirin if your doctor has previously told you to do so if you think you're having a heart attack — but call 911 or emergency medical services first.

Should you take a coated aspirin?
Enteric-coated aspirin is designed to pass through your stomach and not disintegrate until it reaches your small intestine. It may be gentler on the stomach and may be appropriate for some people who take a daily aspirin, especially in those with a history of gastritis or ulcers.

However, some researchers think there's no evidence that taking an enteric-coated aspirin decreases your chance of developing gastrointestinal bleeding. In addition, some research has found that coated aspirin may not be as effective as plain aspirin when taken at the time of a possible heart attack. Talk to your doctor if you're concerned about ways to decrease your bleeding risk.