抑制剂在心血管疾病中的应用ppt课件.pptVIP

Use of Analgesics Most commonly used medications in the US by survey data #1: acetaminophen #2: ibuprofen #3: aspirin – 50% of users on for cardiovascular prophylaxis Among most frequently prescribed meds to those over 65 OTC analgesic use underreported to healthcare providers and 10-40% of those prescribed NSAIDs concomitantly use OTC NSAIDs Use of Analgesics Each year in the US: Over 30 billion OTC NSAID tablets sold (~$2 billion) Over 70 million NSAID prescriptions written NSAIDs have been potentially implicated in ~16,500 deaths and ~100,000 hospitalizations for adverse events; most are due to GI bleeds or renal impairment These admits cost the healthcare system ~$2 billion. Treatment of NSAID-related gastrointestinal side effects accounts for one third of the cost of arthritis therapy Even though advanced age is well-known factor for adverse GI and renal events, over half of patients over 65 have been prescribed NSAIDs. Use of non-aspirin NSAIDs in conjunction with aspirin for primary prophylaxis may increase the risk of first MI 22,000 male physicians on aspirin 325 mg QOD or placebo Aspirin use was associated with a 44% relative risk reduction of first MI Concomitant NSAID use for ? 60 days/yr associated with increased risk of first MI (RR 2.86; 95% CI 1.25-6.56) Possible Adverse Interactions between NSAIDs and ASA Use of NSAIDS in conjunction with ASA in patients after 1st CV admission (angina, MI, CVA, TIA, PVD) 7,107 patients Administration of ibuprofen with aspirin was associated with an increased risk of all-cause mortality (adjusted HR 1.93, 95% CI 1.30-2.87, p=0.001) and CV mortality (1.73, 1.05-2.84, p=0.031) compared to administration of ASA alone Similar risks were found among patients in ASA alone, ASA plus diclofenac, and ASA plus other (non-Ibuprofen) NSAIDS. Platelets in Hemostasis Vascular injury Platelet adhesion Binding to exposed vWF/collagen Platelet activation ADP, 5HT, PF4, etc are released Signals cause COX conversion of arach