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本帖最后由 朋友 于 2024-4-11 22:03 编辑
我怎么看人家梅奥诊所说肠溶剂的药效会导致吸收延迟，导致效果更差而且并不能防止溃疡的效果啊。
DEAR MAYO CLINIC: I take low-dose aspirin each day to prevent heart trouble, based on my doctor’s recommendation. Should I take enteric-coated aspirin to protect my stomach?
ANSWER: It depends, but you probably don’t need enteric-coated aspirin. Enteric-coated aspirin is designed to resist dissolving and being absorbed in the stomach. As such, enteric-coated aspirin passes into the small intestine, where it’s absorbed into the bloodstream. The purported goal is to prevent stomach ulcers and bleeding that can sometimes occur with aspirin use.
When it comes to preventing a heart attack or stroke, the purpose of taking low-dose aspirin is to help prevent the development of harmful — or deadly — artery-blocking blood clots. However, with enteric-coated aspirin, research indicates that bloodstream absorption may be delayed and reduced, compared to regular aspirin absorption. Regular aspirin is quickly dissolved and absorbed in the stomach. As a result, enteric-coated aspirin may not be as effective as regular aspirin at reducing blood clot risk.
Also, the gastrointestinal benefit of enteric-coated aspirin is minimal to nonexistent. When it comes to rates of ulceration and bleeding, there’s no difference between enteric-coated and regular aspirin. The risk of ulcers and bleeding probably comes from aspirin’s effects in the bloodstream, rather than from where the drug dissolves and is absorbed.
Research isn’t fully settled on every nuance of enteric-coated aspirin versus regular aspirin. Indeed, the most important factor with aspirin successfully preventing cardiovascular problems is regularly taking it at the dose recommended by your health care provider. However, the weight of evidence is on the side of taking aspirin without enteric coating to prevent harmful blood clots. If you can’t find aspirin without an enteric coating, crushing or chewing an enteric-coated aspirin eliminates the effect of the enteric coating. (adapted from Mayo Clinic Health Letter) — Dr. Brian Shapiro, Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida
再比如看看研究数据 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551818/
效果：
Within the enteric-coated aspirin cohort, the primary effectiveness end point occurred in 297 participants (cumulative incidence at median follow-up 6.6%) in the 81-mg dose group and 246 participants (7.2%) in the 325-mg dose group (adjusted hazard ratio [AHR], 1.13; 95% CI, 0.88-1.45) (Table 2, Figure 2). Similar results were observed with uncoated aspirin (AHR, 0.99; 95% CI, 0.83-1.18) with an interaction of P = .41 across the groups. All-cause mortality did not significantly differ across the 4 cohorts (AHR, 0.88; 95% CI, 0.63-1.23 for enteric-coated aspirin vs AHR, 0.90; 95% CI, 0.72-1.13 for uncoated aspirin; interaction P = .90) (Table 2). Grouping participants by aspirin formulation regardless of dose showed no difference in effectiveness outcomes (AHR, 0.94; 95% CI, 0.80-1.09; P = .40) (eTable 2 and eFigure 1 in Supplement 3). There was no significant interaction between enteric coating and the presence of ARM on the effectiveness end points (eTable 3 in Supplement 3).
出血：
Overall bleeding requiring blood product transfusion (major bleeding) was low in ADAPTABLE. Across the 4 cohorts, there was no significant interaction of major bleeding by aspirin dose or formulation (Table 2, Figure 3A). Within the enteric-coated aspirin group, there was a small but significant increase in major bleeding with 325-mg dose aspirin (AHR, 2.37; 95% CI, 1.02-5.50) but no difference in major bleeding in the uncoated aspirin cohort (AHR, 0.89; 95% CI, 0.49-1.64; interaction P = .07) (Table 2, Figure 3A). There was also no significant difference in GI tract bleeding across the 4 formulations of aspirin (AHR, 1.27; 95% CI, 0.73-2.22 vs AHR, 1.19; 95% CI, 0.76-1.84; interaction P = .85) (Table 2, Figure 3B). Grouping participants by aspirin formulation regardless of dose showed no difference in safety outcomes (AHR, 0.82; 95% CI, 0.49-1.37; P = .46) (eTable 2 and eFigure 2 in Supplement 3). There was no significant interaction between enteric-coated aspirin and the presence of ARM on major or GI tract bleeding (eTable 3 in Supplement 3).
再比如这个研究就更直球了
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403009/
ECA treatment is not an effective mechanism against GI protection, and it is highly associated with small bowel injury. So the coating does not reduce risk of GI complications.
ECA（肠溶镀层的阿司匹林）不仅不能保护胃肠道，甚至与小肠损伤相关。
https://link.springer.com/article/10.1007/s00228-022-03391-2
Of 42 patients, ischemic strokes were confirmed in both P-ASA (81%) and EC-ASA (67%) arms. ASA non-responsiveness showed no significant difference between the two formulations (P-ASA vs. EC-ASA; 28.6% vs 23.8%; P = 0.726). Univariate and multivariate logistic regression analysis showed that patients treated with EC-ASA were more likely to have a lower rate of non-responders compared to P-ASA (unadjusted OR 0.78; 95% CI 0.20, 3.11); with the risk highest in type 2 diabetic patients with HBA1c > 6.5% (adjusted OR 6; 95% CI 1.02, 35.27; P = 0.047). No incidence of GIT bleeding observed throughout the study.
而且我就奇了怪了，怎么别人做实验关注的都是镀层的阿司匹林可能降低药效，都在做实验证明药效不会因为加了个镀层产生显著差距，到了国内这些医生口中就变成有镀层的就是好好好，外星镀层China集采阿司匹林学不来的？我们的医生是从来不读文献的吗？
不管怎么说，数据摆在这里，你要说吃起来口头感觉不一样那也许是有可能，但是你要说效果（无论好的坏的）有显著区别我只能说你真的**滴坏了。
我建议你赶紧去超市买点200￥一瓶的维生素C补补脑子，顺便多去听听楼下发鸡蛋的健康讲座
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楼主: gigbt
发表于 2024-4-11 19:32
。如果在这里创造的收益能让医保少干几件背刺临床医生的事情，那我可能还应该给国产阿司匹林多摇旗呐喊几下。
所以氯吡格雷会促进胃酸分泌吗？我之前抗凝用的是利伐沙班，前段时间医生改成氯吡格雷，后来我的胃就老是觉得胃酸偏多，明明年初查胃镜当时胃的状况还好转了……
