Acetylsalicylic acid (ASA) refers to drugs with antipyretic, anti-inflammatory and antiplatelet effects. In medical practice, it has been used for more than 125 years, therefore it is one of the most studied medicinal substances. Moreover, ASA is now available in the form of a cardioform to reduce the risk of coronary artery thrombosis, which prevents the development of myocardial infarction. A typical example is Aspecard, which contains acetylsalicylic acid in a dosage optimal for the antiplatelet effect.
Information on the release form and manufacturer
The manufacturer of the medicine is the Ukrainian company Stirolbiofarm. According to the production technology used, the drug is available in the form of a gastro-soluble form in a dose of 100 mg in one tablet. Tablet layout methods:
- cardboard packaging of 120 tablets (10 blisters for 12 tablets);
- polymer container of 100 tablets.
The Aspecard tablet contains 100 mg of ASA, microcrystalline cellulose, croscarmellose sodium, colloidal silicon dioxide, stearic acid.
Recommendations for the appointment
Aspecard has a rather narrow application, although the instructions for it contain recommendations for the treatment of many diseases, including rheumatic pathologies. The manufacturer recommends the use of “Aspecard” as an antipyretic or analgesic. In fact, at a given dosage of acetylsalicylic acid, the drug can only be effectively used as a drug that prevents platelet aggregation.
Indications for use "Aspeckard"
About Aspecard, instructions for use, expert reviews and clinical studies provide a lot of information regarding antiplatelet therapy. It is shown in the following situations:
- with (ACS) acute coronary syndrome (at the stage of acute myocardial infarction with elevation, depression or intact ST segment location, with unstable angina pectoris);
- with ONMK (ischemic stroke or transient ischemic attack);
- in the case of proven coronary heart disease as a means of preventing ACS and stroke;
- in the prevention of repeated episodes of ACS and stroke;
- in the presence of varicose veins of the lower extremities;
- as a prophylactic that prevents shunt thrombosis after CABG;
- with arterial hypertension in case of high cardiovascular risk.
High cardiovascular risk is an aggregate concept, including the presence of target organ damage in case of arterial hypertension and associated diseases: diabetes mellitus, coronary heart disease, and CVB.
Features of dosage regimens recommended by the manufacturer
For Aspecard, the manufacturer’s instructions are not the main patient guide for treatment. It does not contain information about taking the drug in various clinical situations, starting with the prevention of atherothrombosis in coronary heart disease and CVB and ending with acute circulatory disorders of the brain and heart. This omission is considered negligent and unprofessional attitude to the release of drugs and related information materials. It also creates the prerequisites for the publication of a mass of articles in which the recommended dosages diverge.
Dosage regimens based on international recommendations
Based on international recommendations developed by the European Community of Cardiology (ESC) and the American Heart Association (AHA) and adapted by the Ministry of Health, the modes of use of acetylsalicylic acid are as follows:
- at the stage of emergency care for acute coronary syndrome, it is required to give the patient 3 tablets of “Aspecard 100” to chew. Instructions for use are ignored, and a single dose is 300 mg;
- in chronic cardiac ischemia (CHD), one tablet 100 mg after evening dinner is prescribed for continuous use;
- with arterial hypertension in patients with an already high risk of cardiovascular complications, as well as with venous varicose disease of the lower extremities, 100 mg (1 tablet) is also taken continuously in the evening after dinner.
The instructions for ESC and AHA do not provide for other methods of prescribing Aspecard. It is also important to note that the standard dose of Aspecard is 100 mg of ASA. For the prevention of the above diseases, in accordance with the instructions of ESC and AHA, a dose of 75 mg is used. However, 100 mg is prescribed to patients after CABG in order to prevent shunt thrombosis. In other cases, it is recommended to use 75 mg, that is, the amount of ASA that has a sufficient antiplatelet effect and has a minimum risk of gastrotoxicity.
Also, the manufacturer does not provide important information about drug withdrawal. According to statistics, a sudden cessation of intake is the cause of 10.2% of acute cardiovascular complications. Moreover, they occur after about 10.6 days from the time of cancellation of ASA. This period is average and reflects the time during which the entire platelet population with a functioning cyclooxygenase is restored. As a result, the possibility of blood clots is restored again. Therefore, the drug should be taken continuously, and when complications from the gastrointestinal tract appear, the appointment of another antiplatelet agent instead of Aspeckard is required.
Contraindications for taking Aspecard
The safety of all pharmacological preparations is relative, since they have side effects. However, they cause some contraindications. In particular:
- with blood coagulation disorders (hemorrhagic diathesis, hemophilia A and B);
- with violations of the functions of the stomach (erosion, acute ulcers of the stomach and duodenum 12);
- with pregnancy in the first trimester and during lactation;
- with severe renal or liver failure;
- with an allergic reaction to salicylates;
- in children under 18 years of age;
- in the presence of bronchial asthma;
- in the treatment of methotrexate.
These contraindications are absolute, although some of them are temporary: lactation, pregnancy, erosion and gastrointestinal ulcers, children's age. Moreover, there is also a group of conditions, the presence of which requires constant monitoring by a doctor. This is the simultaneous use of antiplatelet agents with anticoagulants, as well as the treatment of patients after coronary artery bypass grafting. In case of impaired renal function, the instructions for use attached to the Aspecard preparation require a dosage reduction or complete gradual withdrawal of the medicine.
Joint effects of Aspeckard
Acetylsalicylic acid has a number of effects that enhance or inhibit the action of a number of drugs. In particular:
- ASA enhances the effect of any antiplatelet agents and anticoagulants;
- ASA enhances the antipyretic and analgesic effect of NSAIDs, enhances the antirheumatic effect of "Meloxicam";
- when combined with cytostatics enhances their gastrotoxicity;
- when taken with alcohol, the risk of developing ulcer complications or bleeding increases;
- glucocorticoids enhance the gastrotoxicity of Aspeckard;
- ASA, when used together with diuretics, weakens the diuretic effect of Furosemide, Torasemide, and Spironolactone.
- "Aspecard" weakens the effect of uricosuric agents: "Probenecid", "Etamida", "Sulfinpyrazone";
- nonabsorbable antacids significantly reduce the absorption of Aspecard.
The likelihood of an overdose and its symptoms
Regarding the Aspecard drug, instructions, reviews and application statistics confirm a rather high level of safety when taken according to indications and with the exception of contraindications. This means that at the prescribed dose of 100 mg, the medicine is quite safe, although it is necessary to control your well-being. Moreover, due to the presence of a contingent of patients with suicidal tendencies, as well as the risk that the child will take the ASA tablets, it is necessary to detail the likelihood of an overdose and its symptoms.
In case of mild salicylate poisoning, provoked by the use of the Aspecard drug not according to the doctor’s recommendations, the following conditions are symptoms: dizziness, pain in the pit of the pit of the fossa, in the umbilical region, sometimes lower back pain, especially in patients with kidney disease. With an overdose, trembling, vomiting, sometimes with bloody streaks, is also observed. First aid is artificial induction of vomiting: plentiful cold drink, intake of activated charcoal and enterosorbents, patient delivery to the hospital.
It is important that the instructions for use do not indicate toxic doses of Aspecard. They are different for different weight and age of the patient. For example, in an adult, mild ASA overdose symptoms occur with a single dose of about 5-7 grams of acid. In children, an overdose of 1.5 grams of a single dose is enough. A significant overdose occurs when adults use 7-9 grams, and children 2-2.5 grams of ASA.
This degree of drug overdose is manifested by the above disorders with the involvement of cognitive functions. Attention is lost, tinnitus begins, thinking becomes confused, speech is slurred. Vomiting occurs frequently, the patient quickly loses fluid with vomiting, quickens breathing, acute urinary retention appears, and body temperature rises. It is impossible to help the patient in such a situation on his own - delivery to the intensive care unit for infusion therapy with sodium bicarbonate, lactate is required.
Features of the therapeutic effect of Aspeckard
The instructions for use attached to the Aspecard preparation contain an indication for taking one tablet per day (100 mg / day). This dose of ASA is sufficient to inhibit platelet cyclooxygenase. The result is inhibition of the synthesis of thromboxane A2, which completely inhibits the ability of platelet cells to aggregate. This eliminates the likelihood of thrombosis, which is the cause of myocardial or cerebral infarction.
To provide an antithrombotic effect, acetylsalicylic acid must be absorbed into the blood. However, a certain amount of it also acts in the stomach, also inhibiting cyclooxygenase-1 and its isoforms in the mucous membrane of the organ. The result of this mechanism is a side effect - a decrease in the protective abilities of the mucous-carbonate barrier. This increases the risk of erosion and stomach ulcers, provokes gastrointestinal bleeding. Enteric forms can also cause bleeding, but the incidence of such a side effect is extremely small.
Pregnancy and lactation
The opinion of experts, based on the evaluation of statistics and a number of experiments, allows you to have a clear idea about the use of the drug "Aspecard" during pregnancy. In particular, in the 1st trimester its use is prohibited. In the 2nd and 3rd trimester, the use is allowed, however, after assessing its therapeutic benefit and comparing the risks of taking. In the vast majority of clinical situations, the appointment of ASA is unjustified, although other NSAIDs can also increase the risk of miscarriage.
During lactation, it is prohibited to use the Aspecard drug, its analogues, generics, as well as all medicines with acetylsalicylic acid in the composition. The reason for this is the ingestion of a drug substance into breast milk. With it, it penetrates the body of the child. Moreover, its danger lies in the high risk of developing Reye's syndrome - extremely severe hepatic encephalopathy, which causes brain edema and the death of a child. For similar reasons, it is prohibited to prescribe a drug under the age of 16-18 years.
Characteristics of reviews of specialists and patients
Characterizing the drug "Aspecard" patient reviews in many cases are biased. They positively evaluate the price of the medicine, since it is almost the lowest among analogues. However, reviews regarding practical use are less indicative due to the impossibility of assessing patients the degree of reduction in the risk of vascular thrombosis. In terms of side effects noted by patients, the drug is characterized as quite safe.
The opinions of experts are unambiguous: firstly, the drug effectively reduces the risks of thrombosis, and secondly, the patients' adherence to antiplatelet therapy is higher due to the low price of the Aspecard drug. Analogs in the class of antiplatelet agents are significantly higher. Domestic enteric-soluble drug "Acecardol" is 50% more expensive, while the cost of imported is 7-10 times higher. But, based on the fewer side effects of enteric agents, as well as on economic findings, it is advisable to give Acecardolum priority. The cost of a monthly treatment will be about 20 rubles.
The objective disadvantage of the cardiotherapy "Aspecard"
The instructions for use attached to the Aspecard 100 preparation state that the medicine is available in tablets. They dissolve in the stomach and create a high concentration. Providing a local gastrotoxic effect, the drug loses in safety to other drugs, namely enteric. The risk of gastric bleeding when using the latter is much less.
Examples of safer drugs are the following: Acekardol, Polokard, Cardiomagnyl, Aspirin Cardio. Moreover, these agents also contain magnesium hydroxide capable of protecting the mucous membranes from damage by acetylsalicylic acid. Nevertheless, the Aspecard drug can be used to prevent thrombosis, although with limitations. But patients with erosion of the mucous membrane, ulcers of the duodenum or stomach, including chronic ones, are recommended to take enteric-soluble cardioforms of acetylsalicylic acid.
Non-industry use of the cardiologic medicine "Aspecard"
Most of the available instructions for use indicate the presence of anti-inflammatory and antipyretic properties of the drug "Aspecard 100". In fact, the medicine has full therapeutic effects in a 5-fold single dose - 500 mg each. A dosage of 100 mg is exclusively cardiological, and its effects are not enough to effectively reduce the temperature in infectious diseases.
The cardioform of the drug, produced in a dose of 100 mg, is suitable for pain relief and relief of fever only with a single dose of 5 tablets. Moreover, the predominance of selectivity to cyclooxygenase 1 leads to the presence of many adverse reactions. Therefore, as an antipyretic, Aspecard tablets are, of course, suitable. However, at the moment there are a number of safer drugs in a number that show greater selectivity for cyclooxygenase 2. They also have fewer side effects associated with impaired proliferation of the gastrointestinal epithelium.
Safe class analogues of Aspecard
A similar trend is observed in the treatment of rheumatic diseases. Moreover, the instructions for use attached to the Aspecard preparation contain information about their treatment. But the recommended dose is about 5-8 grams per day.
In such an amount, acetylsalicylic acid exhibits an incomparably stronger gastrotoxic effect than when taking the medications "Meloxicam", "Celecoxib", "Roferoxib" and others. And as an antipyretic, the most valuable class analogue is Ibuprofen.