geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-3-2021-371-375geriatr-204Research ArticleПРОБА ПЕРАРациональность и безопасность приема ацетилсалициловой кислоты пациентами старческого возрастаRationality and safety of acetylsalicylic acid therapy in centenarianshttps://orcid.org/0000-0002-4497-1277АлимоваЕ. Р.AlimovaE. R.

Санкт-Петербург

Saint Petersburg

https://orcid.org/0000-0003-0048-268XЕруслановаК. А.EruslanovaK. A.

Ерусланова Ксения Алексеевна, младший научный сотрудник лаборатории сердечно-сосудистого старения ОСП

Москва

Eruslanova Kseniia Alekseevna, MSc, junior researcher, laboratory of cardiovascular agineng

Moscow

ФГБОУ ВО Военно-Медицинская Академия им. С.М. КироваРоссияKirov Military Medical AcademyRussian FederationФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава РоссииРоссияPirogov Russian National Research Medical University of Ministry of Health of the Russian Federation, Russian Gerontology Research and Clinical CentreRussian Federation20211510202103379382Copyright © Алимова Е.Р., Ерусланова К.А., 20212021Алимова Е.Р., Ерусланова К.А.Alimova E.R., Eruslanova K.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/204

Цель исследования. Оценить наличие или отсутствие показаний для приема ацетилсалициловой кислоты (АСК), а также безопасность терапии среди сверхдолгожителей согласно клиническим рекомендациям.Материалы и методы. В исследование был включен 81 пациент (71 женщина и 10 мужчин). Критерии включения: пациенты 95 лет и старше (средний возраст 98,3±1,89), получающие комбинированную терапию, включая АСК. У пациентов в ходе исследования оценивались анамнестические данные по сопутствующим заболеваниям и фармакотерапии, проводилось комплексное обследование (общий анализ крови (ОАК), эхокардиография). В работе были проанализированы результаты данных исследований и выполнены статистические расчеты.Результаты. Из общего количества пациентов, вошедших в исследование, регулярно принимают АСК 41,9% (n=34). Из них 41,7% (n=14) — в качестве вторичной профилактики сердечно-сосудистых событий (наличие задокументированных сердечно-сосудистых заболеваний в анамнезе и/или данных ЭхоКГ). А у 58,3% (n=20) пациентов, согласно современным рекомендациям, показания к назначению отсутствовали. Во время анализа среди пациентов, которым, согласно клиническим рекомендациям, терапия АСК не была рекомендована, были выявлены группы, у которых был повышен риск желудочно-кишечных кровотечений (ЖКК): 30% (n=6) пациентов имели в анамнезе язвенную болезнь желудка или двенадцатиперстной кишки, 20% (n=4) принимали препараты из груп- пы нестероидных противовоспалительных средств, у 25% (n=3) пациентов была тромбоцитопения. У 4 (15,6%) пациентов из данных подгрупп присутствуют одновременно несколько факторов, увеличивающих риск ЖКК.Выводы. Из общего количества пациентов, вошедших в исследование и принимающих АСК, у большей половины показаний к проведению терапии не было, у подавляющего большинства этой группы были выявлены дополнительные факторы риска развития ЖКК. В то же время у четверти всех участников были показания, но терапия не проводилась. Суммируя все вышесказанное, перед назначением и продолжением терапии АСК врач должен проанализировать целесообразность и безопасность проводимой терапии.

Aim. To assess the presence or absence of indications for taking acetylsalicylic acid (ASA), as well as the safety of therapy among centenarians according to clinical guidelines.Materials and methods. The study included 81 patients (71 women and 10 men). Inclusion criteria: patients 95 years and older (mean age 98.3 ± 1.89) receiving combination therapy, including ASA. In the study, the patients' history data on concomitant diseases and pharmacotherapy were assessed, a comprehensive examination (complete blood count (CBC), echocardiography) was performed. In our work, the results of these studies were analyzed, and statistical calculations were performed.Results. From the total number of patients included in the study, 41.9% regularly take ASA (n=34). In 41.7% (n=14) were taken as secondary prevention of cardiovascular events (the presence of a documented history of cardiovascular disease). According to current recommendations, 58.3% (n=20) of patients had no indications for a prescription. During the analysis among patients for whom according to clinical guidelines ASA therapy was not recommended, groups were identified in which the risk of gastrointestinal bleeding (GIB) was increased: 30% (n=6) patients had a history of gastric ulcer or duodenal ulcer, 20% (n=4) took drugs from the group of non-steroidal anti-inflammatory drugs, 25% (n=3) of patients had thrombocytopenia. In 4 (15.6%) patients from these subgroups, several factors simultaneously increase gastrointestinal bleeding risk.Conclusions. From the total number of patients included in the study and prescribed with ASA, more than half had no indications for therapy; the vast majority of this group had additional risk factors for GIB development. At the same time, a quarter of all participants had indications, but therapy was not prescribed. Summarizing all of the mentioned above, before prescribing and continuing treatment with ASA, clinicians should analyze the therapy's feasibility and safety.

гериатриядолгожителиацетилсалициловая кислотаполипрагмазияgeriatricscentenariansaspirinpolypragmasiaReferencesPeto R., Gray R., Collins R., Wheatley K., Hennekens C., Jamrozik K., Warlow C., Hafner B., Thompson E., Norton S., Gilliland J., Doll R. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J (Clin Res Ed). 1988; 296: 313–316. [PMC free article] [PubMed] [Google Scholar]Peto R., Gray R., Collins R., Wheatley K., Hennekens C., Jamrozik K., Warlow C., Hafner B., Thompson E., Norton S., Gilliland J., Doll R. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J (Clin Res Ed). 1988; 296: 313–316. [PMC free article] [PubMed] [Google Scholar]Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989; 32: 129135. [PubMed] [GoogleScholar]Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989; 32: 129135. [PubMed] [GoogleScholar]The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet. 1998; 351: 233–241. [PubMed] [GoogleScholar]The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet. 1998; 351: 233–241. [PubMed] [GoogleScholar]Hansson L., Zanchetti A., Carruthers S.G., Dahlöf B., Elmfeldt D., Julius S., Ménard J., Rahn K.H., Wedel H., Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT StudyGroup. Lancet. 1998; 351: 1755–1762. [PubMed] [GoogleScholar]Hansson L., Zanchetti A., Carruthers S.G., Dahlöf B., Elmfeldt D., Julius S., Ménard J., Rahn K.H., Wedel H., Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT StudyGroup. Lancet. 1998; 351: 1755–1762. [PubMed] [GoogleScholar]de Gaetano G.; Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet. 2001; 357: 89–95. [PubMed] [GoogleScholar]de Gaetano G.; Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet. 2001; 357: 89–95. [PubMed] [GoogleScholar]Ridker P.M., Cook N.R., Lee I.M., Gordon D., Gaziano J.M., Manson J.E., Hennekens C.H., Buring J.E. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005; 352: 1293–1304. [PubMed] [GoogleScholar]Ridker P.M., Cook N.R., Lee I.M., Gordon D., Gaziano J.M., Manson J.E., Hennekens C.H., Buring J.E. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005; 352: 1293–1304. [PubMed] [GoogleScholar]Belch J., MacCuish A., Campbell I., Cobbe S., Taylor R., Prescott R., Lee R., Bancroft J., MacEwan S., Shepher J., Macfarlane P., Morris A., Jung R., Kelly C., Connacher A., Peden N., Jamieson A., Matthews D., Leese G., McKnight J., O’Brien I., Semple C., Petrie J., Gordon D., Pringle S., MacWalter R.; Prevention of Progression of Arterial Disease and Diabetes Study Group; Diabetes Registry Group; Royal College of Physicians Ediburgh. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008; 337: a1840. [PMC freearticle] [PubMed] [GoogleScholar]Belch J., MacCuish A., Campbell I., Cobbe S., Taylor R., Prescott R., Lee R., Bancroft J., MacEwan S., Shepher J., Macfarlane P., Morris A., Jung R., Kelly C., Connacher A., Peden N., Jamieson A., Matthews D., Leese G., McKnight J., O’Brien I., Semple C., Petrie J., Gordon D., Pringle S., MacWalter R.; Prevention of Progression of Arterial Disease and Diabetes Study Group; Diabetes Registry Group; Royal College of Physicians Ediburgh. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008; 337: a1840. [PMC freearticle] [PubMed] [GoogleScholar]Ogawa H., Makayama M., Morimoto T., Uemura S., Kanauchi M., Doi N., Jinnouchi H., Sugiyama S., Saito Y.; Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008; 300: 2134–2141. [PubMed] [GoogleScholar]Ogawa H., Makayama M., Morimoto T., Uemura S., Kanauchi M., Doi N., Jinnouchi H., Sugiyama S., Saito Y.; Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008; 300: 2134–2141. [PubMed] [GoogleScholar]Fowkes F.G., Price J.F., Stewart M.C., Butcher I., Leng G.C., Pell A.C., Sandercock P.A., Fox K.A., Lowe G.D., Murray G.D.; Aspirin for Asymptomatic Atherosclerosis Trialists. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA. 2010; 303: 841–848. [PubMed] [GoogleScholar]Fowkes F.G., Price J.F., Stewart M.C., Butcher I., Leng G.C., Pell A.C., Sandercock P.A., Fox K.A., Lowe G.D., Murray G.D.; Aspirin for Asymptomatic Atherosclerosis Trialists. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA. 2010; 303: 841–848. [PubMed] [GoogleScholar]Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Antithrombotic Trialists' (ATT) Collaboration., Baigent C., Blackwell L., Collins R., Emberson J., Godwin J., Peto R., Buring J., Hennekens C., Kearney P., Meade T., Patrono C., Roncaglioni M.C., Zanchetti A. Lancet. 2009 May 30; 373 (9678): 1849–60.Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Antithrombotic Trialists' (ATT) Collaboration., Baigent C., Blackwell L., Collins R., Emberson J., Godwin J., Peto R., Buring J., Hennekens C., Kearney P., Meade T., Patrono C., Roncaglioni M.C., Zanchetti A. Lancet. 2009 May 30; 373 (9678): 1849–60.McNeil J.J., Nelson M.R., Woods R.L., et al; ASPREE Investigator Group. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018; 379(16): 1519–1528.McNeil J.J., Nelson M.R., Woods R.L., et al; ASPREE Investigator Group. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018; 379(16): 1519–1528.Bowman L., Mafham M., Wallendszus K., et al; ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018; 379(16): 1529–1539.Bowman L., Mafham M., Wallendszus K., et al; ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018; 379(16): 1529–1539.Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events. A Systematic Review and Meta-analysis. January 22, 2019.Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events. A Systematic Review and Meta-analysis. January 22, 2019.January 22, 2019 Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding EventsA Systematic Review and Meta-analysis. Sean L. Zheng, BM, BCh, MA, MRCP; Alistair J. Roddick, BSc.January 22, 2019 Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding EventsA Systematic Review and Meta-analysis. Sean L. Zheng, BM, BCh, MA, MRCP; Alistair J. Roddick, BSc.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Donna K. Arnett, Roger S. Blumenthal, Michelle A. Albert, Andrew B. Buroker, Zachary D. Goldberger, Ellen J. Hahn, Cheryl Dennison Himmelfarb, Amit Khera, Donald Lloyd-Jones, J. William McEvoy, Erin D. Michos, Michael D. Miedema, Daniel Muñoz, Sidney C. Smith Jr., Salim S. Virani, Kim A. Williams Sr., Joseph Yeboah and Boback Ziaeian.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Donna K. Arnett, Roger S. Blumenthal, Michelle A. Albert, Andrew B. Buroker, Zachary D. Goldberger, Ellen J. Hahn, Cheryl Dennison Himmelfarb, Amit Khera, Donald Lloyd-Jones, J. William McEvoy, Erin D. Michos, Michael D. Miedema, Daniel Muñoz, Sidney C. Smith Jr., Salim S. Virani, Kim A. Williams Sr., Joseph Yeboah and Boback Ziaeian.Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Beer M.H., Ouslander J.G., Rollingher I., Reuben D.B., Brooks J., Beck J.C. (Arch Intern Med. 1991 Sep; 151(9): 1825–32).Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Beer M.H., Ouslander J.G., Rollingher I., Reuben D.B., Brooks J., Beck J.C. (Arch Intern Med. 1991 Sep; 151(9): 1825–32).O’Mahony D., O’Sullivan D., Byrne S., O'Connor M.N., Ryan C., Gallagher P., et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015; 44(2): 213–8.O’Mahony D., O’Sullivan D., Byrne S., O'Connor M.N., Ryan C., Gallagher P., et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015; 44(2): 213–8.Ткачева О.Н., Котовская Ю.В., Рунихина Н.К., Фролова Е.В., Наумов А.В., Воробьева Н.М., Остапенко В.С., Мхитарян Э.А., Шарашкина Н.В., Тюхменев Е.А., Переверзев А.П., Дудинская Е.Н. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020; (1): 11–46. https://doi.org/10.37586/2686-8636-1-2020-11-46Ткачева О.Н., Котовская Ю.В., Рунихина Н.К., Фролова Е.В., Наумов А.В., Воробьева Н.М., Остапенко В.С., Мхитарян Э.А., Шарашкина Н.В., Тюхменев Е.А., Переверзев А.П., Дудинская Е.Н. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020; (1): 11–46. https://doi.org/10.37586/2686-8636-1-2020-11-46Ткачева О.Н., Котовская Ю.В., Рунихина Н.К., Фролова Е.В., Наумов А.В., Воробьева Н.М., Остапенко В.С., Мхитарян Э.А., Шарашкина Н.В., Тюхменев Е.А., Переверзев А.П., Дудинская Е.Н. Клинические рекомендации «Старческая астения». Часть 2. Российский журнал гериатрической медицины. 2020; (2): 115–130. https://doi.org/10.37586/2686-8636-2-2020-115-130Ткачева О.Н., Котовская Ю.В., Рунихина Н.К., Фролова Е.В., Наумов А.В., Воробьева Н.М., Остапенко В.С., Мхитарян Э.А., Шарашкина Н.В., Тюхменев Е.А., Переверзев А.П., Дудинская Е.Н. Клинические рекомендации «Старческая астения». Часть 2. Российский журнал гериатрической медицины. 2020; (2): 115–130. https://doi.org/10.37586/2686-8636-2-2020-115-130Chiang K.F., Shah S.J., & Stafford R.S. (2019). A Practical Approach to Low-Dose Aspirin for Primary Prevention. JAMA. DOI: 10.1001/jama.2019.8388.Chiang K.F., Shah S.J., & Stafford R.S. (2019). A Practical Approach to Low-Dose Aspirin for Primary Prevention. JAMA. DOI: 10.1001/jama.2019.8388.

The authors declare that there are no conflicts of interest present.