引用本文：Walker J. Low-dose aspirin for the prevention of atherothrombosis across the cardiovascular risk continuum. Cardiol Plus 2022;7:64–69.

doi: 10.1097/CP9.0000000000000017

Abstract

At the 2021 International Aspirin Foundation Symposium of Oriental Congress of Cardiology, a panel of distinguished cardiologists from around the world gathered to present their recent research findings and discuss viewpoints of aspirin use along the entire continuum of cardiovascular disease (CVD) prevention in the general population as well as in specific patient groups.

Aspirin produces long-lasting effects on platelet function and cumulative inhibition of platelet thromboxane production by irreversibly inactivating the prostaglandin H-synthase (PGHS). Consistent with saturability of platelet cyclooxygenase 1 (COX-1) inactivation and thromboxane A2 (TXA2) suppression at low doses, a body of convincing evidence showed no additional benefit from high versus low-dose aspirin.

Trials of aspirin as primary prevention trials are challenging due to the low event rate and reduced patient compliance over time. Nevertheless, evidence from the ASCEND and TIPS3 trials supported the benefit of aspirin in primary cardiovascular prevention.

The Chinese population has among the highest CVD risk in the world. Significant achievement has been made in this respect. For example, the benefit of aspirin use as primary prevention is now recognized in the Chinese guidelines similar to the US, European guidelines, with some unique features that are helpful for the Chinese population (eg, greater emphasis on dynamical reassessment of risk versus benefit).

As secondary prevention in patients with transient ischaemic attack (TIA) and minor stroke, low-dose aspirin reduces the risk of major recurrent stroke as well as stroke severity.

Peripheral arterial disease (PAD) management and screening is of growing importance. The COMPASS and VOYAGER studies provide new evidence for dual-pathway inhibition (DPI) antithrombotic therapy with low-dose aspirin and reduced-dose rivaroxaban.

A major concern with the use of aspirin is the risk of gastrointestinal (GI) bleeding. Strategies to protect patients include eradication of Helicobacter pylori infection and co-prescription of proton pump inhibitors. Different P2Y12 inhibitors and low-dose aspirin have similar levels of bleeding risk, but the risk is magnified when these agents are taken together.

研究正文介绍

国际阿司匹林基金会（IAF）成立于1974年，旨在通过分享信息和激发有关阿司匹林各方面的研究兴趣和讨论，增进对阿司匹林的认识和理解。2021年5月28日，IAF受邀在第十五届东方心脏病学会议（OCC）举办其在中国的首次研讨会。OCC大会主席葛均波院士与IAF科学顾问委员会主席Carlo Patrono教授共同主持了研讨会。

研讨会吸引了2.56万名与会者和12万名在线观众，会议内容涵盖阿司匹林的作用机制、阿司匹林在CVD一级预防中的应用、阿司匹林在卒中和PAD二级预防的应用，以及最新指南和改善用药的出血安全性。

多位国际专家分享了他们关于在整个心血管疾病谱中使用阿司匹林的最新研究发现及观点，其中：

意大利罗马天主教大学Carlo Patrono教授阐明了阿司匹林预防动脉粥样硬化血栓形成的作用机制。

阿司匹林不可逆地抑制前列腺素H合成酶(PGHS)的活性，持续抑制血小板血栓素的生成，从而对血小板功能产生长期影响。大量令人信服的证据表明，高剂量阿司匹林与低剂量阿司匹林相比，并无额外益处。

美国哈佛大学J Michael Gaziano教授列举了低剂量阿司匹林预防心血管事件链中严重血管事件的国际研究证据。

由于CVD事件发生率低，并且患者的依从性随时间推移而降低，阿司匹林用作一级预防的试验具有较大挑战性。不过，来自ASCEND和TIPS3试验的证据支持阿司匹林在心血管一级预防中的益处。

中国解放军总医院李小鹰教授进一步指出了中国指南关于低剂量阿司匹林在预防心血管事件链中严重血管事件中的应用。

中国人群是世界上心血管疾病风险最高的人群之一并且已在该方向取得了重大成就。例如，与美国和欧洲的指南类似，中国指南同样认可阿司匹林用作一级预防的好处，并包含一些对中国人群有帮助的独特要点（例如，更加强调对风险与收益的动态重新评估）。

英国牛津大学Peter Rothwell教授分析了低剂量阿司匹林用于卒中二级预防的国际研究现状。

低剂量阿司匹林用作短暂性脑缺血发作（TIA）和轻型卒中患者的二级预防，可降低严重卒中的复发风险和卒中严重程度。

中国复旦大学符伟国教授阐述了双通道抗栓用于心血管疾病中的二级预防。

外周动脉疾病（PAD）的管理和筛查越来越重要。COMPASS和VOYAGER研究为低剂量阿司匹林联合小剂量利伐沙班的双通道抗栓(DPI)治疗提供了新证据。

美国哈佛大学Andrew T Chan教授就提高低剂量阿司匹林的胃肠道安全性作了探讨。

使用阿司匹林的一个主要顾虑是胃肠道（GI）出血风险。保护患者的策略包括根除幽门螺杆菌感染和联合使用质子泵抑制剂。不同的P2Y12抑制剂和低剂量阿司匹林具有相似水平的出血风险，但当同时服用这些药物时，风险会被放大。

通讯作者简介

Jaqui Walker

BSc Hons, PG Dip Advanced Nurse Practitioner and Medical Writer. She has written for the International Aspirin Foundation (IAF) since 2016.

关于本文的更多详情，请阅览Cardiology Plus 2022年第2期第64-69页《Low-dose aspirin for the prevention of atherothrombosis across the cardiovascular risk continuum》，通讯作者为国际阿司匹林基金会Jaqui Walker。

原文链接：

https://journals.lww.com/cardioplus/Fulltext/2022/06000/Low_dose_aspirin_for_the_prevention_of.2.aspx

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