A 62-year-old male patient received propacetamol hydrochloride for analgesia, cefuroxime sodium for anti-infection, adenosine cobalamin for nutrition of nerve, and low molecular weight heparin calcium for anticoagulation for burst fracture of the third lumbar vertebra and multiple fractures of transverse process of lumbar spine caused by traffic accident. The patient′s liver function was normal before medication. He underwent the operation under general anesthesia 2 days later. Low molecular weight heparin calcium was stopped before the operation. On day 3 after the operation (on day 5 of medication), the patient developed abdominal distension and pain. The results of laboratory tests showed alanine aminotransferase (ALT) 9 315 U/L, aspartate aminotransferase (AST) 10 760 U/L, gamma glutamyltransferase (γ-GT) 47 U/L, alkaline phosphatase (ALP) 101 U/L, total bilirubin (TBil) 71.3 μmol/L, direct bilirubin (DBil) 48.5 μmol/L, and indirect bilirubin (IBil) 22.8 μmol/L. Drug-induced liver injury was considered. Propacetamol hydrochloride was discontinued and liver-protective drugs were given. The next day, the patient developed yellow staining of his sclera and whole body skin, then followed by confusion, decreased blood oxygen saturation, low blood pressure, and hypoglycemia. The results of reexamination showed ALT 5 975 U/L, AST 3 659 U/L, γ-GT 100 U/L, ALP 141 U/L, TBil 175.2 μmol/L, DBil 101.4 μmol/L, IBil 73.8 μmol/L, and prothrombin time 21.2 s. The patient was diagnosed as acute liver failure. Cefuroxime sodium and adenosine cobalamin were discontinued and symptomatic and supportive treatments such as increasing blood pressure, fluid supplement, and correction of acidosis were given. However, the patient′s condition was not improved. He was transferred to other hospital on the same day. On the 4th day, he died of multiple organ failure.

A 62-year-old male patient received propacetamol hydrochloride for analgesia, cefuroxime sodium for anti-infection, adenosine cobalamin for nutrition of nerve, and low molecular weight heparin calcium for anticoagulation for burst fracture of the third lumbar vertebra and multiple fractures of transverse process of lumbar spine caused by traffic accident. The patient′s liver function was normal before medication. He underwent the operation under general anesthesia 2 days later. Low molecular weight heparin calcium was stopped before the operation. On day 3 after the operation (on day 5 of medication), the patient developed abdominal distension and pain. The results of laboratory tests showed alanine aminotransferase (ALT) 9 315 U/L, aspartate aminotransferase (AST) 10 760 U/L, gamma glutamyltransferase (γ-GT) 47 U/L, alkaline phosphatase (ALP) 101 U/L, total bilirubin (TBil) 71.3 μmol/L, direct bilirubin (DBil) 48.5 μmol/L, and indirect bilirubin (IBil) 22.8 μmol/L. Drug-induced liver injury was considered. Propacetamol hydrochloride was discontinued and liver-protective drugs were given. The next day, the patient developed yellow staining of his sclera and whole body skin, then followed by confusion, decreased blood oxygen saturation, low blood pressure, and hypoglycemia. The results of reexamination showed ALT 5 975 U/L, AST 3 659 U/L, γ-GT 100 U/L, ALP 141 U/L, TBil 175.2 μmol/L, DBil 101.4 μmol/L, IBil 73.8 μmol/L, and prothrombin time 21.2 s. The patient was diagnosed as acute liver failure. Cefuroxime sodium and adenosine cobalamin were discontinued and symptomatic and supportive treatments such as increasing blood pressure, fluid supplement, and correction of acidosis were given. However, the patient′s condition was not improved. He was transferred to other hospital on the same day. On the 4th day, he died of multiple organ failure.

Objective To compare the outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) taking aspirin for primary prophylaxis to those not taking it.Methods Patients without any vascular disease (coronary artery or cerebrovascular disease) who were admitted to the 89th Hospital of PLA between 2006 and 2016 with non-variceal upper gastrointestinal bleeding were included.The frequencies of in-hospital mortality,re-bleeding,severe bleeding,need for surgery or embolization,and of a composite outcome of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics.We also compared the frequency of in hospital complications and length of hospital stay between the two groups.Results Of the 179 eligible patients,47 were on aspirin and 132 patients were on no antithrombotics (control group).Patients in the aspirin group (58.4 years) were elder than that in controls (66.8 years) (P ＜0.01).Patients in the aspirin group had significantly more co-morbidities,including diabetes mellitus [25.5 ％ (12/47) vs 12.1％ (16/132)] and hypertension [46.8％ (22/47) vs 28.0％ (37/132)],respectively,as well as dyslipidemia [21.3％ (10/47) vs 6.1％ (8/132)] (P ＜ 0.01).Smoking was more frequent in the aspirin group [36.2％ (17/47) vs 22.7％ (30/132),P ＜ 0.05].The frequencies of endoscopic therapy and surgery were similar in both groups,while the frequencies of in-hospital complications and re-bleeding were similar in the two groups,too.However,the patients who were on aspirin had lower in hospital mortality rates (2.1％ vs 13.6％,P ＜0.01),shorter hospital stay (4.9 d vs 7.0 d,P ＜0.05),and fewer composite outcomes (10.6％ vs 24.2％,P ＜ 0.05).Conclusions Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes.Thus aspirin may have a protective effect beyond its cardiovascular benefits.