過猶不及－Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease

人體是最精妙的機器，各種器官和生理反應互相作用，維持一個平衡狀態。

而現代人常說的養生、多吃什麼對健康好，可以應用在每個人身上嗎？

像這次我跟我媽見面，她就說她原本喝醋希望養生，可是被告誡喝太多了！還有三酸甘油脂太低，反而讓膽固醇過高起來…(三酸甘油脂和膽固醇的生理連動是怎樣反應的，其實我也不清楚)

Skyscape's MedAlert: Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease


阿斯匹靈是常用來預防心血管疾病的藥物，主要作用是抑制血小板凝血的功能，來達到減少血栓的目的。保栓通(clopidogrel)同樣也用在預防心血管疾病，作用和阿斯匹靈類似，都是抑制血小板凝集的功能。副作用，就是不容易止血、容易流血。


不過預防也不代表百分之百保證不會發生；所以有人就提議：＂那並用兩種藥物，是不是預防效果更好？＂


沒錯，經過研究顯示，兩個藥一起用，更能降機心血管疾病的風險。

Clopidogrel plus aspirin reduced risk of cardiovascular events compared with aspirin alone

可是換個角度來說，出血的風險也大為增加；統計上來說，如果1000個病患接受兩種藥物合併治療，有13個人因此得利(預防心血管疾病)，但是也會造成6個人嚴重出血。

The CURE study enrolled only patients with a recent non-ST segment elevation acute coronary syndrome. The use of clopidogrel plus aspirin, compared with placebo plus aspirin, was associated with a lower risk of cardiovascular events (OR: 0.87, 95% CI 0.81 to 0.94; P<0.01) and a higher risk of major bleeding (OR 1.34, 95% CI 1.14 to 1.57; P<0.01). Overall, we would expect 13 cardiovascular events to be prevented for every 1000 patients treated with the combination, but 6 major bleeds would be caused. In the CURE trial, for every 1000 people treated, 23 events would be avoided and 10 major bleeds would be caused. In the CHARISMA trial, for every 1000 people treated, 5 cardiovascular events would be avoided and 3 major bleeds would be caused.

因此，在權衡利弊得失之後，目前的建議是只有在急性冠心症的病患，合併兩種藥物治療的好處大於壞處。

The available evidence demonstrates that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events and an increased risk of bleeding compared with aspirin alone. Only in patients with acute non-ST coronary syndrome benefits outweigh harms.

從現有資料看起來，即使是心血管疾病風險高的人、或是已經有心血管疾病的患者，也不應合併兩種藥物來長期預防。

Given the available evidence and until new data are published, clinicians should not add clopidogrel to standard long-term aspirin therapy for preventing cardiovascular disease in people at high risk of cardiovascular disease and in those with established cardiovascular disease. In patients with acute non-ST coronary syndromes, there is evidence of benefit outweighing harms caused by major bleeding and combination treatment should be considered.