阿斯匹林在初級預防中的最佳應用－族群和劑量的選擇

The Best Usage of Aspirin in Primary Prevention-Indication, Dosage and Ethnic Issues

林中生(Chung-Sheng Lin) ； 許惠恒(Wayne H-H Sheu) ； 陳昌明(Chang-Ming Chern) ； 吳造中(Chau-Chung Wu) ； 何橈通(Low-Tone Ho) ； 許重義(Chung Y. Hsu) ； 徐粹烈(Tsui-Lieh Hsu) ； 盧玉強(Yuk-Keung Lo) ； 陳明豐(Ming-Fong Chen)

《內科學誌》 18卷1期 (2007/02) Pp. 1-10

https://doi.org/10.6314/JIMT.2007.18(1).01

摘要

Aspirin是目前廣泛應用於臨床的藥物，尤其在抗血小板凝集功能的使用頗受重視，但是近年來很多研究和臨床治驗結果與原本的治療率則不盡相同，出現了一些新的結論。Aspirin抗血小板凝集功能對很多疾病有預防作用，如心血管和代謝類疾病等，因此在初級預防的應用方面存在著不少討論的空間。本文從Aspirin對心血管、中風、糖尿病的影響以及其在藥理學上的研究進行討論，以使Aspirin的用途能夠有進一步詳細的釐清。在本篇文章中分別就Aspirin在預防心血管事件中的益處、Aspirin應用於糖尿病和代謝綜合症的新進展、Aspirin在中風初級預防策略中重要作用之共識、Aspirin反應的多樣性等內容進行討論，並針對現階段Aspirin在臨床應用的族群和劑量選擇等問題加以探討。所得結論為Aspirin廁腸溶錠片比傳統Aspirin錠的冑腸耐受性好：Aspirin的抗血小板治療可明顯減少心血管事件的發生，長期應用低劑量Aspirin (75~150mg/day)可獲得滿意的效果Aspirin可明顯降低女性首次中風尤其是缺血性中風的危險性，亦可降低男性初發心肌梗塞的危險性；同時Aspirin可降低糖尿病病友發生。。血管事件的危險性；此外美國心臟學會(American Heart Association, AHA)和美國糖尿病學會(American Diabetes Association, ADA)推蒍使用Aspirin作為心血管疾病高危險群初級和次級預防的措施，劑量為75~150mg/day。即使如此，由於目前比較缺乏東方人（台灣）在這方面進一步的研究數據，因此需要慎重使用，鼓勵採用個體化的健康管理方法，讓臨床醫師能更恰當的用藥。

關鍵字

阿斯匹林 ； 中風 ； 劑量 ； 糖尿病 ； 代謝綜合症 ； 初級預防

並列摘要

Aspirin is a well-known drug applied in clinical therapy. However, results of aspirin researches and clinical trials are different from traditional therapeutical guidelines. Some new conclusions emerged. Aspirin takes in a prevention role in some diseases, such as cardiovascular (CV) events, diabetes, and metabolic syndrome. However, how to apply aspirin in primary prevention still needs more discussion. In this article, we discuss the effect of aspirin in the field of cardiology, stroke, diabetes and pharmacology. We also discuss the dosage and appropriate usage of aspirin in Taiwan's population. The content of this article included the view points of the benefit of aspirin in the prevention of CV events from cardiologists, diabetologist's and neurologists view. We also discuss the starring role of aspirin from pharmacological issues or clinical reality? The conclusions are that enteric-coated aspirin has good gastrointestinal tolerability than common caplets; Anti-platelet therapies such as long-term use of low dose aspirin (75-150mg/day) can significantly reduce cardiovascular events; Aspirin can reduce the risk of first stroke in women and myocardial infarction in man; It also can reduce the risk of cardiovascular events in diabetes. Besides, American Heart Association and American Diabetes Association recommend that aspirin can be used as primary and secondary prevention in high risk population of cardiovascular disease. The individual management is recommended when people who have high risk of CV events and use aspirin in primary or secondary prevention.

並列關鍵字

Aspirin ； Stroke ； Dosage ； Diabetes ； Metabolic syndrome ； Primary prevention