Chapter 1366 【1366】Poverty Has No Choice
Hearing that what Pan listed out were the key points of knowledge, the other students nodded frequently.
Yue Wentong did not deny: "The patient is taking warfarin."
As a patient after PCI operation, following the doctor's advice is to take warfarin anticoagulant drugs for a long time, the purpose is to prevent thrombosis in the stent. In-stent thrombosis is more fatal than in-stent restenosis. Acute myocardial infarction caused by thrombus formation can cause a mortality rate of 20 to 40%.
Anticoagulants alone are not enough, and doctors often prescribe aspirin as antiplatelet therapy for patients. Aspirin is the most widely used antiplatelet drug clinically, belonging to thromboxane A2 (TXA2) inhibitors.
Laymen may find it strange to hear it. Isn’t it okay to use anticoagulant drugs alone? Why do you need to add antiplatelet drugs? Isn't it the same antithrombotic? There are three types of antithrombotic drugs. In addition to the above two, the other is the most direct, called thrombolytic drugs. In fact, thrombolytic drugs are a commonly used clinical treatment for patients with acute myocardial infarction when there is no drug stent in the early stage and the bare stent is not reimbursed by medical insurance. Thrombolytics are just as expensive, but cheaper than stenting and bypass surgery. If you think about its technical essentials, you will know where it is cheap. It does not require surgery, and it has low technical requirements for hospitals and doctors. It can be carried out in small and medium hospitals, and the former must be carried out in large hospitals.
The poor people have no choice.
Doctors in major hospitals do not like thrombolytic drugs, because the use of thrombolytic drugs must be time-sensitive, and it is best to use them within three hours of myocardial infarction, otherwise the effect will be greatly reduced and will not be effective. Secondly, thrombolytic drugs are ineffective against refractory thrombus, which means that even after thrombolysis, angiography must be performed before stenting. Moreover, the medicine affects the whole body, unlike surgery limited to a part of the body, the complications caused by thrombolytic therapy will be terrible. Many patients with underlying diseases must use it with caution, and the elderly with various systemic problems are contraindicated. The problem is that the elderly also have more myocardial infarction.
Patients who have a little money and are persuaded by doctors immediately pk off thrombolytic therapy and thrombolytic drugs. After surgery, two other antithrombotic drugs are used in combination to make the effect better.
Although anticoagulant drugs and antiplatelet drugs are antithrombotic drugs, they should be similar to thrombolytic drugs, but they are really two types of drugs with completely different mechanisms of action. Whether it is physiological hemostasis or abnormal thrombus formation, it is actually two processes of platelet aggregation and blood coagulation. The protagonist of the former is platelets, which run to a piece and adhere to the blood vessel wall to stop bleeding or form a thrombus. The important role of the latter is the coagulation factor, which is activated from a quiet state by receiving the signal of blood vessel damage, prompting the fibrin to change from soluble to insoluble, and pulling into a fibrin network, blood cells, etc., to become a blood clot.
According to this principle, the antiplatelet drugs developed should drive platelets away and prevent them from releasing aggregation and adhesion. Anticoagulant drugs prevent blood coagulation factors from being activated and transformed.
What Xie Wanying learned before and after her rebirth is that warfarin and aspirin are not enough for patients after PCI to truly resist thrombosis. What is needed is anticoagulant plus dual antiplatelet therapy, which is abbreviated as DAPT in English.
Why not at this stage? Because another class of antiplatelet drugs used in DAPT is not thromboxane A2 (TXA2) inhibitors such as aspirin.