Listening to what classmate Pan listed were the key points of knowledge, other students nodded frequently.
Yue Wentong did not deny it: "The patient is taking warfarin."
As a patient after PCI surgery, you have to take warfarin-type anticoagulants for a long time according to the doctor's advice. The purpose is to prevent stent thrombosis. In-stent thrombosis is more fatal than in-stent restenosis. The acute myocardial thrombosis caused by thrombosis segment
Infarction has a mortality rate of 20 to 40%.
Anticoagulants alone are not enough. Doctors often prescribe aspirin to patients as antiplatelet treatment. Aspirin is the most widely used antiplatelet drug in clinical practice and is a thromboxane a2 (txa2) inhibitor.
Laymen may find it strange when they hear this. If a single anticoagulant drug doesn’t work, why should we add an antiplatelet drug? Aren’t they all the same antithrombotic drugs? There are three types of antithrombotic drugs. In addition to the above two, the other one is the most direct.
, called thrombolytic drugs. In fact, thrombolytic drugs were a commonly used clinical treatment option for rescuing patients with acute myocardial infarction when there were no drug stents in the early days and bare stents were not reimbursed by medical insurance. Thrombolytic drugs are equally expensive, but they will
It is cheaper than stent surgery and bypass surgery. If you think about its technical essentials, you will know how cheap it is. There is no need for surgery, and it has low technical requirements for hospitals and doctors. It can be carried out in small and medium-sized hospitals. The former must be carried out in large hospitals.
People are so poor that they have no choice.
Doctors in big hospitals don’t like thrombolytic drugs, because the use of thrombolytic drugs must be timed, and it is best to use them within three hours of myocardial infarction, otherwise the effect will be greatly reduced and ineffective. Secondly, thrombolytic drugs are effective for refractory blood clots.
Ineffective means that even after thrombolysis, angiography must be done and a stent must be added. Moreover, the medicine affects the whole body, unlike surgery that is limited to local parts of the body. The complications caused by thrombolysis treatment will be terrible. Many patients have
Patients with underlying diseases must use it with caution, and it is even more contraindicated for older people with various systemic problems. Elderly people with problems also have more myocardial infarctions.
Patients who have some money and are persuaded by doctors immediately give up thrombolytic treatment and thrombolytic drugs. After surgery, they use two other anti-thrombotic drugs in combination to achieve better results.
Although anticoagulants and antiplatelet drugs are both antithrombotic drugs, and they are similar to thrombolysis, they are really two types of drugs with completely different mechanisms of action. Whether people have physiological hemostasis or abnormal thrombosis, in fact,
It is the two processes of platelet aggregation and coagulation. The protagonist of the former is platelets, which stick to the blood vessel wall to stop bleeding or form thrombus. The important role of the latter is coagulation factor, which changes from a quiet state to a signal of vessel damage.
It is activated, causing fibrin to change from soluble to insoluble, forming a fibrin network, forming a network of blood cells and turning into a blood clot.
According to this principle, the antiplatelet drugs developed are designed to drive away platelets and prevent them from releasing aggregation and adhesion. Anticoagulants prevent coagulation factors from being activated or transformed.
What Xie Wanying learned before and after her rebirth was that warfarin and aspirin were not enough for post-PCI patients to truly fight thrombosis. What was needed was anticoagulant plus dual antiplatelet therapy, the latter abbreviated in English as dapt.
Why not use it at this stage? Because the other type of antiplatelet drug used by dapt is not a thromboxane a2 (txa2) inhibitor such as aspirin.
