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目的:调查长期规律服用阿司匹林(ASA)对于脑梗死患者二级预防的获益与引发出血事件的风险。方法:收集2012年4月~2014年4月普陀区人民医院脑梗死住院患者901例。根据是否长期服用ASA分为暴露组439例和非暴露组462例,前瞻性追踪调查6个月,分别记录其终点事件(脑梗死复发、症状性颅内出血及上消化道出血),分析评价ASA在二级预防中的获益与风险。结果:暴露组与非暴露组脑梗死复发率分别为8.7%和13.4%(P<0.05),暴露组缺血性卒中复发率减少4.7%,NNT=21。暴露组与非暴露组总症状性出血事件发生率分别为23.9%和16.2%(P<0.05),暴露组总症状性出血事件增加7.7%,NNT=13。其中症状性上消化道出血发生率暴露组为16.4%,非暴露组为11.7%,差异有统计学意义(P<0.05),暴露组增加了4.7%,NNT=21;症状性颅内出血发生率暴露组为7.5%,非暴露组为4.5%,差异无统计学意义(P>0.05)。结论:长期服用ASA虽能降低4.7%的脑梗死复发率,但是总症状性出血事件也有明显增加(7.7%),尤其是上消化道出血事件增加4.7%,颅内出血略有增加趋势。ASA预防卒中复发,获益与风险并存。
PURPOSE: To investigate the long-term benefit of aspirin (ASA) for secondary prevention in patients with cerebral infarction and the risk of bleeding. Methods: 901 hospitalized patients with cerebral infarction in Putuo District People’s Hospital from April 2012 to April 2014 were collected. According to whether long-term use of ASA was divided into exposure group and non-exposure group, 439 cases 462 cases, prospective follow-up survey of 6 months, were recorded end points (recurrent cerebral infarction, symptomatic intracranial hemorrhage and upper gastrointestinal bleeding), analysis of ASA Benefits and risks in secondary prevention. Results: The recurrence rates of cerebral infarction in exposed and non-exposed groups were 8.7% and 13.4% respectively (P <0.05). The recurrence rate of ischemic stroke was reduced 4.7% and NNT was 21 in exposed group. The incidences of total symptomatic bleeding in exposed and non-exposed groups were 23.9% and 16.2%, respectively (P <0.05). Total symptomatic bleeding increased 7.7% and NNT was 13 in the exposed group. Among them, the incidence of symptomatic upper gastrointestinal bleeding was 16.4% in the exposed group and 11.7% in the non-exposed group, with a significant difference (P <0.05); the incidence of symptomatic upper gastrointestinal bleeding was 4.7% and the NNT was 21; the incidence of symptomatic intracranial hemorrhage The exposed group was 7.5%, non-exposed group 4.5%, the difference was not statistically significant (P> 0.05). CONCLUSIONS: Long-term use of ASA reduces the recurrence rate of 4.7% of cerebral infarctions, but the overall incidence of symptomatic hemorrhage also increased significantly (7.7%). In particular, the incidence of upper gastrointestinal bleeding increased 4.7% and the rate of intracranial hemorrhage increased slightly. ASA to prevent recurrent stroke, benefit and risk co-exist.