{"id":22483,"date":"2023-04-17T07:51:06","date_gmt":"2023-04-17T00:51:06","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22483"},"modified":"2023-04-17T11:05:08","modified_gmt":"2023-04-17T04:05:08","slug":"aspirin-va-cac-chi-dinh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/17\/aspirin-va-cac-chi-dinh-lam-sang\/","title":{"rendered":"Aspirin v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng"},"content":{"rendered":"<p><strong>Aspirin \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1edfi nh\u00e0 khoa h\u1ecdc ng\u01b0\u1eddi \u0110\u1ee9c \u2013 Felix Ho|mann. Ban \u0111\u1ea7u, thu\u1ed1c ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 s\u1ed1t v\u00e0 gi\u1ea3m \u0111au. M\u00e3i t\u1edbi n\u0103m 1955, c\u00e1c nh\u00e0 khoa h\u1ecdc m\u1edbi ph\u00e1t hi\u1ec7n th\u00eam t\u00e1c d\u1ee5ng kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u1ee7a thu\u1ed1c n\u00e0y do c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t thromboxane A2.<\/strong><\/p>\n<p><strong>T\u1eeb \u0111\u00f3, aspirin \u0111\u01b0\u1ee3c coi l\u00e0 n\u1ec1n t\u1ea3ng trong li\u1ec7u ph\u00e1p ch\u1ed1ng huy\u1ebft kh\u1ed1i trong h\u1ed9i ch\u1ee9ng m\u1ea1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/strong><\/p>\n<h2><strong>1.C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng chung<\/strong><\/h2>\n<p>Aspirin ng\u0103n ch\u1eb7n con \u0111\u01b0\u1eddng ho\u1ea1t h\u00f3a ti\u1ec3u c\u1ea7u c\u1ee7a thromboxane A2 b\u1eb1ng vi\u1ec7c acetyl h\u00f3a kh\u00f4ng h\u1ed3i ph\u1ee5c enzyme cyclooxygenase (COX).\u00a0 T\u00e1c d\u1ee5ng c\u1ee7a aspirin t\u1ed3n t\u1ea1i trong su\u1ed1t th\u1eddi gian s\u1ed1ng c\u1ee7a ti\u1ec3u c\u1ea7u (trung b\u00ecnh kho\u1ea3ng 8-9 ng\u00e0y).<\/p>\n<p>Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12 bao g\u1ed3m c\u00e1c thu\u1ed1c nh\u00f3m thienopyridine v\u00e0 non-thienopyridine, t\u00e1c d\u1ee5ng qua vi\u1ec7c \u1ee9c ch\u1ebf kh\u00f4ng h\u1ed3i ph\u1ee5c vi\u1ec7c g\u1eafn ph\u00e2n t\u1eed ADP l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a n\u00f3 tr\u00ean b\u1ec1 m\u1eb7t ti\u1ec3u c\u1ea7u, v\u00ec v\u1eady ng\u0103n ng\u1eeba s\u1ef1 ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 glycoprotein IIb\/IIIa, l\u00e0 m\u1ed9t protein m\u00e0ng c\u00f3 nhi\u1ec7m v\u1ee5 li\u00ean k\u1ebft v\u1edbi fibrinogen t\u1ea1o th\u00e0nh m\u1ea1ng l\u01b0\u1edbi gi\u00fap ti\u1ec3u c\u1ea7u ng\u01b0ng t\u1eadp l\u1ea1i v\u1edbi nhau.<\/p>\n<h2>2. Ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<h3>2.1 D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t b\u1ec7nh tim m\u1ea1ch:<\/h3>\n<ul>\n<li>C\u01a1n \u0111au th\u1eaft ng\u1ef1c, sau can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da ho\u1eb7c ph\u1eabu thu\u1eadt c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh, sau nh\u1ed3i m\u00e1u c\u01a1 tim.<\/li>\n<li>\u0110\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o. B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean.<\/li>\n<\/ul>\n<p>T\u1eeb nh\u1eefng n\u0103m 1980, c\u00f3 nhi\u1ec1u d\u1eef li\u1ec7u l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng aspirin trong d\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t sau khi Nghi\u00ean c\u1ee9u Qu\u1ed1c t\u1ebf l\u1ea7n th\u1ee9 2 v\u1ec1 nh\u1ed3i m\u00e1u c\u01a1 tim (Second International Study of Infarct Survival \u2013 ISIS-2) \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. Vi\u1ec7c s\u1eed d\u1ee5ng aspirin li\u1ec1u 300 mg trong nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong t\u1edbi 23%. Th\u1eed nghi\u1ec7m v\u1ec1 ch\u1ed1ng huy\u1ebft kh\u1ed1i (The Antithrombotic Trialists\u2019 Collaboration) k\u1ebft lu\u1eadn r\u1eb1ng sau nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, aspirin l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u1ec1 sau t\u1edbi 25% (s\u1ed1 ng\u01b0\u1eddi c\u1ea7n \u0111i\u1ec1u tr\u1ecb l\u00e0 28 b\u1ec7nh nh\u00e2n v\u1edbi th\u1eddi gian theo d\u00f5i tr\u00ean 2 n\u0103m).<\/p>\n<h3>2.2 D\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t b\u1ec7nh tim m\u1ea1ch:<\/h3>\n<p>Hi\u1ec7n nay kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng aspirin th\u01b0\u1eddng quy trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t.<\/p>\n<p>Vai tr\u00f2 c\u1ee7a aspirin trong d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch ch\u01b0a th\u1ef1c s\u1ef1 r\u00f5 r\u00e0ng, c\u1ea7n c\u00e2n b\u1eb1ng gi\u1eefa nguy c\u01a1 b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 nguy c\u01a1 xu\u1ea5t huy\u1ebft. Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng aspirin th\u01b0\u1eddng quy cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ec7nh l\u00fd tim m\u1ea1ch th\u1ea5p ho\u1eb7c trung b\u00ecnh (kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh tim m\u1ea1ch \u01b0\u1edbc t\u00ednh th\u1ea5p h\u01a1n 5% trong 10 n\u0103m).<\/p>\n<p>V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ec7nh l\u00fd tim m\u1ea1ch cao (nguy c\u01a1 m\u1eafc b\u1ec7nh l\u00fd tim m\u1ea1ch tr\u00ean 5% trong 10 n\u0103m), vi\u1ec7c s\u1eed d\u1ee5ng aspirin th\u01b0\u1eddng quy c\u0169ng c\u00f2n nhi\u1ec1u tranh c\u00e3i; nhi\u1ec1u chuy\u00ean gia cho r\u1eb1ng kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng th\u01b0\u1eddng quy k\u1ec3 c\u1ea3 v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. S\u1eed d\u1ee5ng aspirin li\u1ec1u th\u1ea5p \u01b0\u1edbc t\u00ednh c\u00f3 th\u1ec3 ph\u00f2ng ng\u1eeba cho 10-15 ng\u01b0\u1eddi trong t\u1ed5ng s\u1ed1 1000 ng\u01b0\u1eddi trong 2 n\u0103m, tuy nhi\u00ean nguy c\u01a1 xu\u1ea5t huy\u1ebft t\u0103ng 2 \u0111\u1ebfn 3 l\u1ea7n. Trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, vi\u1ec7c s\u1eed d\u1ee5ng aspirin li\u1ec1u th\u1ea5p c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft n\u1ed9i s\u1ecd, v\u00ec v\u1eady c\u1ea7n duy tr\u00ec huy\u1ebft \u00e1p d\u01b0\u1edbi m\u1ee9c 150\/90 mmHg khi thu\u1ed1c \u0111\u01b0\u1ee3c kh\u1edfi tr\u1ecb v\u1edbi m\u1ee5c \u0111\u00edch d\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t.<\/p>\n<h2>3. Li\u1ec1u d\u00f9ng<\/h2>\n<ul>\n<li>D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t b\u1ec7nh tim m\u1ea1ch: Aspirin li\u1ec1u th\u1ea5p 75-100 mg\/24h \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c \u1ed5n \u0111\u1ecbnh, nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u n\u00e3o ho\u1eb7c thi\u1ebfu m\u00e1u n\u00e3o c\u1ee5c b\u1ed9 tho\u00e1ng qua, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i bi\u00ean.<\/li>\n<li>Li\u1ec1u n\u1ea1p (loading dose) trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p tr\u01b0\u1edbc can thi\u1ec7p: 162 \u2013 325 mg. D\u1ef1 ph\u00f2ng ti\u00eam ph\u00e1t b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch t\u01b0\u01a1ng t\u1ef1 li\u1ec1u d\u1ef1 ph\u00f2ng th\u1ee9 nh\u1ea5t.<\/li>\n<\/ul>\n<h2>4. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/h2>\n<ul>\n<li>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: Ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng v\u1edbi aspirin, lo\u00e9t d\u1ea1 d\u00e0y \u2013 t\u00e1 tr\u00e0ng \u0111ang ho\u1ea1t \u0111\u1ed9ng, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a g\u1ea7n \u0111\u00e2y, \u0111\u1ed9t qu\u1ef5 xu\u1ea5t huy\u1ebft n\u00e3o g\u1ea7n \u0111\u00e2y, c\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 \u0111\u00f4ng m\u00e1u nh\u01b0 b\u1ec7nh Hemophilia, b\u1ec7nh Von Willebrand, gi\u1ea3m ti\u1ec3u c\u1ea7u, b\u1ec7nh l\u00fd v\u1ec1 gan n\u1eb7ng.<\/li>\n<li>Th\u1eadn tr\u1ecdng: Hen ph\u1ebf qu\u1ea3n, t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng ki\u1ec3m so\u00e1t, ti\u1ec1n s\u1eed lo\u00e9t d\u1ea1 d\u00e0y \u2013 t\u00e1 tr\u00e0ng.<\/li>\n<\/ul>\n<h2>5. S\u1ef1 \u0111\u1ec1 kh\u00e1ng aspirin<\/h2>\n<p>Trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng, hi\u1ec7n t\u01b0\u1ee3ng \u201ckh\u00e1ng aspirin\u201d \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn nh\u01b0ng \u1ea3nh h\u01b0\u1edfng t\u1edbi hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng r\u00f5 r\u00e0ng (kho\u1ea3ng 10% b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c).<\/p>\n<h2>6. T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/h2>\n<p>Aspirin ngay c\u1ea3 khi s\u1eed d\u1ee5ng v\u1edbi li\u1ec1u th\u1ea5p c\u00f3 th\u1ec3 l\u00e0m kh\u1edfi ph\u00e1t co th\u1eaft ph\u1ebf qu\u1ea3n \u1edf 20% c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 hen ph\u1ebf qu\u1ea3n.<\/p>\n<p>Theo <a href=\"http:\/\/canhgiacduoc.org.vn\/\">C\u1ea3nh gi\u00e1c d\u01b0\u1ee3c<\/a>, c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u1ee7a aspirin kh\u00e1 ph\u1ed5 bi\u1ebfn, v\u1edbi bi\u1ec3u hi\u1ec7n t\u1eeb c\u1ea3m gi\u00e1c bu\u1ed3n n\u00f4n sau u\u1ed1ng aspirin v\u00e0i gi\u1edd, t\u1edbi c\u00e1c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a n\u1eb7ng. Aspirin l\u00e0m gia t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a t\u1ea1i c\u00e1c \u1ed5 lo\u00e9t \u1edf h\u00e0nh t\u00e1 tr\u00e0ng h\u01a1n l\u00e0 c\u00e1c \u1ed5 lo\u00e9t t\u1ea1i d\u1ea1 d\u00e0y, v\u00e0 th\u01b0\u1eddng x\u1ea3y ra trong nh\u1eefng ng\u00e0y \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h3>6.1 Y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a khi d\u00f9ng aspirin c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng:<\/h3>\n<ul>\n<li>Tu\u1ed5i: Nguy c\u01a1 xu\u1ea5t huy\u1ebft t\u0103ng l\u00ean 2 l\u1ea7n sau m\u1ed7i 10 n\u0103m \u1edf b\u1ec7nh nh\u00e2n tr\u00ean 55 tu\u1ed5i.<\/li>\n<li>Gi\u1edbi: Nguy c\u01a1 t\u0103ng g\u1ea5p 2 l\u1ea7n \u1edf nam gi\u1edbi so v\u1edbi n\u1eef gi\u1edbi. Ti\u1ec1n s\u1eed lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng, ti\u1ec1n s\u1eed xu\u1ea5t huy\u1ebft ho\u1eb7c th\u1ee7ng d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng. S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ph\u1ed1i h\u1ee3p kh\u00e1c nh\u01b0 NSAIDs, thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu serotonin ch\u1ecdn l\u1ecdc (SSRIs).<\/li>\n<\/ul>\n<p>C\u1ea7n \u0111i\u1ec1u tr\u1ecb NSAIDs k\u00e9o d\u00e0i trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd: vi\u00eam x\u01b0\u01a1ng kh\u1edbp, th\u1ea5p kh\u1edbp, \u0111au th\u1eaft l\u01b0ng m\u1ea1n t\u00ednh. M\u1eafc m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd kh\u00e1c ph\u1ed1i h\u1ee3p nh\u01b0 b\u1ec7nh l\u00fd v\u1ec1 gan, th\u1eadn, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. Nhi\u1ec5m vi khu\u1ea9n Helicobacter pylori. Nghi\u1ec7n r\u01b0\u1ee3u. H\u00fat thu\u1ed1c l\u00e1 nhi\u1ec1u.<\/p>\n<h3>6.2 Chi\u1ebfn l\u01b0\u1ee3c gi\u00fap gi\u1ea3m nguy c\u01a1 xu\u1ea5t huy\u1ebft khi s\u1eed d\u1ee5ng aspirin:<\/h3>\n<ul>\n<li>D\u00f9ng aspirin li\u1ec1u th\u1ea5p 75 \u2013 100 mg\/24h, ch\u1ec9 d\u00f9ng li\u1ec1u cao khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh. D\u00f9ng aspirin sau \u0103n no.<\/li>\n<li>Tr\u00e1nh\/h\u1ea1n ch\u1ebf d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c NSAIDs ho\u1eb7c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng c\u1ea3 \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 \u0111\u01b0\u1eddng ti\u00eam.<\/li>\n<li>\u0110\u00e1nh gi\u00e1 l\u1ea1i nguy c\u01a1 xu\u1ea5t huy\u1ebft c\u0169ng nh\u01b0 \u0111\u01a1n thu\u1ed1c \u0111ang d\u00f9ng, xem x\u00e9t d\u1eebng ho\u1eb7c gi\u1ea3m b\u1edbt li\u1ec1u n\u1ebfu nguy c\u01a1 xu\u1ea5t huy\u1ebft t\u0103ng l\u00ean.<\/li>\n<li>H\u1ea1n ch\u1ebf u\u1ed1ng r\u01b0\u1ee3u bia.<\/li>\n<li>Gi\u1ea3m b\u1edbt ho\u1eb7c ng\u1eebng h\u1eb3n vi\u1ec7c h\u00fat thu\u1ed1c l\u00e1.<\/li>\n<li>C\u00e2n nh\u1eafc s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p PPIs n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u nguy c\u01a1. \u0110i\u1ec1u tr\u1ecb di\u1ec7t H.pylori n\u1ebfu c\u00f3 nhi\u1ec5m.<\/li>\n<\/ul>\n<h2>7. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c<\/h2>\n<ul>\n<li>Thu\u1ed1c gi\u1ea3m \u0111au: c\u1ea7n tr\u00e1nh s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p v\u1edbi NSAIDs v\u00ec c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a thu\u1ed1c.<\/li>\n<li>Thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng: l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft khi d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi warfarin ho\u1eb7c c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng kh\u00e1c. C\u1ea7n tr\u00e1nh s\u1ef1 ph\u1ed1i h\u1ee3p thu\u1ed1c tr\u1eeb khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh s\u1eed d\u1ee5ng c\u1ea3 hai lo\u1ea1i.<\/li>\n<li>Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m: l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft khi d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf t\u00e1i h\u1ea5p thu ch\u1ecdn l\u1ecdc tr\u00ean serotonin v\u00e0 venlafaxine.<\/li>\n<li>Thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o: aspirin l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft methotrexate, n\u00ean tr\u00e1nh s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u1ea3 hai nh\u00f3m thu\u1ed1c n\u00e0y n\u1ebfu c\u00f3 th\u1ec3 v\u00e0 theo d\u00f5i ch\u1eb7t ch\u1ebd li\u1ec1u d\u00f9ng methotrexate<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Aspirin \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n b\u1edfi nh\u00e0 khoa h\u1ecdc ng\u01b0\u1eddi \u0110\u1ee9c \u2013 Felix Ho|mann. Ban \u0111\u1ea7u, thu\u1ed1c ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 s\u1ed1t v\u00e0 gi\u1ea3m \u0111au. M\u00e3i t\u1edbi n\u0103m 1955, c\u00e1c nh\u00e0 khoa h\u1ecdc m\u1edbi ph\u00e1t hi\u1ec7n th\u00eam t\u00e1c d\u1ee5ng kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u1ee7a thu\u1ed1c n\u00e0y do c\u00f3 t\u00e1c d\u1ee5ng [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":22490,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Aspirin v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"Aspirin l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c d\u00f9ng nhi\u1ec1u trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd tim m\u1ea1ch. 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