I stopped taking aspirin because I felt uncomfortable in my stomach, but it didn't prevent the recurrence of cerebral infarction.

A patient with cerebral infarction who was discharged from hospital one year ago was admitted to the neurology department of the hospital again. This was her second time to be hospitalized for cerebral infarction. The symptoms this time were very serious and it was still unknown whether she could recover. When communicating with her family, we learned that she felt stomach discomfort a few months ago and thought it was the side effect of taking aspirin, so she stopped taking the medicine without authorization.

The doctor shook his head regretfully. He had met several similar patients who did not communicate with the doctor when they encountered problems during medication and stopped taking the medication on their own initiative. As a result, they failed to prevent the recurrence of cerebral infarction.

1. Aspirin is the "cornerstone" for preventing cardiovascular and cerebrovascular diseases. The pathogenesis of myocardial infarction and cerebral infarction is mainly related to atherosclerosis. The cause of the disease is the rupture of unstable atherosclerotic plaques. The surface of the ruptured plaques will induce platelets to aggregate and form thrombi. If it occurs in the heart, it is myocardial infarction, and if it occurs in the brain, it is cerebral infarction.

Aspirin can bind to cyclooxygenase on platelets and produce irreversible inhibition on platelets, thus playing an anti-platelet aggregation role. Once atherosclerosis is formed, it cannot be completely eliminated, so people who have already had myocardial infarction or cerebral infarction have a high probability of recurrence. They need to take aspirin continuously to inhibit the new platelets generated every day, and they cannot stop taking the drug in order to play an effective preventive role.

2. Aspirin can damage the digestive system. In addition to inhibiting cyclooxygenase on platelets, aspirin also inhibits cyclooxygenase in other parts of the human body, inhibiting the production of prostaglandins. Prostaglandins can promote blood circulation in the gastric mucosa, regeneration of gastric parietal cells, and secretion of bicarbonate, and can protect the gastric mucosa from erosion by gastric acid and pepsin.

However, aspirin inhibits the production of prostaglandins, which will cause the gastric mucosal defense to decrease, resulting in abdominal discomfort, nausea, vomiting, diarrhea, and even gastrointestinal ulcers and bleeding. Digestive tract damage is the most common side effect of taking aspirin, with a comprehensive incidence of nearly 20%. Therefore, preventing and treating digestive tract damage is the most important issue that people who take aspirin should pay attention to.

3. How to prevent and treat gastrointestinal damage caused by aspirin? Before using the drug, high-risk groups that are prone to gastrointestinal damage should be screened, including those who have suffered from gastrointestinal ulcers (gastric, duodenal ulcers, etc.) and gastrointestinal bleeding; those who take other antiplatelet drugs (such as clopidogrel, ticagrelor, etc.) in addition to aspirin; those who use anticoagulants (such as warfarin, rivaroxaban, etc.) in combination; those who use glucocorticoids (such as dexamethasone, prednisone, etc.) for a long time; those who suffer from indigestion and gastroesophageal reflux; and those who are over 65 years old.

The above are all high-risk groups that are prone to digestive tract damage. Before using aspirin, they need to be screened for Helicobacter pylori. Those who are positive need to be cleared. The clearing method requires the selection of 1 bismuth agent, 1 antacid, and 2 antibiotics under the guidance of a doctor to form a "quadruple regimen" of medication.

When taking aspirin, you can preventively use drugs to protect the gastric mucosa, such as proton pump inhibitors (omeprazole, lansoprazole, rabeprazole, etc.), or H2 receptor antagonists (ranitidine, famotidine, etc.), which inhibit gastric acid secretion, weaken the activity of pepsin, and protect the gastric mucosa from damage.

At the same time, aspirin should be used in a standardized manner. Enteric-coated aspirin tablets should be used and swallowed on an empty stomach half an hour before meals. Do not break or chew them to avoid direct irritation to the gastric mucosa. Use a small dose of aspirin, 75-150 mg per day, usually 100 mg per day. When gastrointestinal symptoms occur, a doctor should examine and evaluate before deciding whether to stop the medication, and you should not stop the medication without authorization. Even if you stop the medication, you need to resume taking the medication as soon as possible after the gastrointestinal symptoms are relieved.

In summary, when taking aspirin to prevent cardiovascular and cerebrovascular diseases, you need to take the medicine regularly and cannot stop taking it without authorization. Eradicating Helicobacter pylori and using gastric mucosal protection drugs under the guidance of a doctor can reduce the risk of gastrointestinal ulcers and bleeding by 80%. Everyone should remember one thing, if you find a problem when taking the medicine, you should consult a doctor or pharmacist in time, and do not reduce or stop taking the medicine without authorization. I am pharmacist Huazi, welcome to follow me and share more health knowledge.