Aspirin To Treat Coronary Heart Disease (chd) Related Factors Of Upper Gastrointestinal Hemorrhage And To Prevent Chinese And Western Medicine

In recent years,with the increase of people who need primary and secondary prevention of coronary heart disease because of the coronary heart disease,hypertension and diabetes, more and more people began to receive antiplatelet therapy.Aspirin is the most commonly used antiplatelet drugs and is widely used in primary and secondary prevention of cardiovascular disease. Upper gastrointsetinal bleeding adverse reaction of aspirin attracts more and more attention.Upper gastrointestinal bleeding often accompany with acute peripheral circulatory failure that is caused by hypovolemia,and will be life-threatening if not timely rescued.In addition,heavy bleeding can lead to reduced myocardial perfusion and high incidence of coronary ischemic events;During bleeding treament,antiplatelet therapy often needs to be stoped that will increase the risk of myocardial re-ischemia and stent thrombosis significantly.If the patient who take antiplatelet drug have upper gastrointestinal bleeding.mortality rate is extremely high,because he will be not only at high death risk of upper gastrointestinal bleeding,but also have a high risk of death due to cardiovascular and cerebrovascular ischemic and thrombotic events.Due to analgesic effect of aspirin, patients with peptic ulcer and bleeding often have no gastrointestinal symptoms.So it is not easy to detect in time and will delay treatment and increase mortality.We should attach great importance to the aspirin-related upper gastrointestinal bleeding and actively prevent.Aspirin can cause ulcers or mucosal erosion which can bleed.The complex mechanisms of mucosal injury include inhibition of prostaglandin synthesis,reducing mucosal blood flow,increasing in inflammatory mediators,epithelial cell energy metabolic disorders,growth factor reducing,inhibition of platelet aggregation,etc.The measures of reduced aspirin-related upper gastrointestinal bleeding on coronary heart disease include:strictly controlled aspirin indications and reducing risk factors;using the appropriate dose and formulations of aspirin;hemorrhage monitoring;combination of other western drugs protecting gastric mucosa;other western drugs alternative to aspirin;combination of herbs protecting gastric mucosa;herbs alternative to aspirin;dialectically use of aspirin. Risk factors of upper gastrointestinal bleeding include age, history of ulcer or bleeding. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs, corticosteroids, aticoagulants. antiplatelet drugs,and so on.Evidence based medicine showed that75-150mg is the best dose of aspirin which is safe and effective.Enteric aspirin has not the direct stimulation of the mucosa so reduce the incidence of upper gastrointestinal bleeding.PGE2may predict upper gastrointestinal bleeding but further studies are needed.Through a variety of ways, Chinese medicine protect the gastrointestinal mucosa and prevent upper gastrointestinal adverse reactions.Proton pump inhibitors can significantly reduce the incidence of upper gastrointestinal bleeding and rebleeding. Aspirin should be combined with proton pump inhibitors or Chinese medicine in high risk groups of upper gastrointestinal bleeding.There is no more safe and effective western drug to replace aspirin.Some Chinese herbs also have antiplatelet effect. Who take herbs instead of aspirin to treat coronary heart disease can also obtain good effect.Therefore,high risk groups of bleeding and patients of bleeding can use herbs for treatment of coronary heart disease without using aspirin.We should have a comprehensive systematic study of traditional Chinese medicine(TCM) pattern law of aspirin-related upper gastrointestinal bleeding to find the most appropriate TCM pattern and the most unfit TCM pattern of using aspirin through large-scale clinical trials.Then use aspirin dialectically according to Chinese medicine theory,that is to say suitable for use and not suitable for choosing other drugs to replace aspirin.Improving the correctness of aspirin use from the TCM point of view,and that is expected to reduce the incidence of aspirin-related upper gastrointestinal bleeding significantly.