Listening to what classmate Pan listed were 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 must take long-term anticoagulants like warfarin as directed by your doctor in order to prevent stent thrombosis. In-stent thrombosis is more fatal than in-stent restenosis. Acute myocardial infarction caused by thrombosis will have a mortality rate of 20 to 40%.
Anticoagulants alone are not enough, and doctors often prescribe aspirin as antiplatelet therapy. 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 is not effective, why should an antiplatelet drug be added? Aren’t they all anti-thrombotic? There are three types of anti-thrombotic 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 medicated stents in the early days and bare stents were not reimbursed by medical insurance. Thrombolytic drugs are just as expensive, but cheaper than stent surgery and bypass surgery. If you think about its technical essentials, you will know the advantages. It does not require surgery and 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.
The common 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 ineffective against refractory thrombus, which means that even after thrombolysis is completed, angiography must be done again and a stent must be applied. Moreover, medicine affects the whole body, unlike surgery which is limited to local parts of the body. The complications caused by thrombolytic treatment can be very scary. Many patients with underlying diseases must use it with caution, and elderly people with various systemic problems are even more contraindications. Problems: Older people also have more myocardial infarctions.
Patients who have some money and are persuaded by doctors immediately give up thrombolytic treatment and thrombolytic drugs. For surgery, use a combination of two other anti-thrombotic drugs after surgery to achieve better results.
Although anticoagulants and antiplatelet drugs are both antithrombotic drugs, and they are different from thrombolysis, they seem to be similar, but they are really two types of drugs with completely different mechanisms of action. Whether it is physiological hemostasis or abnormal thrombosis, it is actually two processes: 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 latter plays an important role as a coagulation factor. It is activated from a quiet state upon receiving a signal of blood vessel damage, causing fibrin to change from soluble to insoluble, forming a fibrin network and forming a network of blood cells and other blood cells to form a blood clot.
According to this principle, the antiplatelet drugs developed should drive away platelets and prevent them from releasing aggregation and adhesion. Anticoagulants prevent coagulation factors from being activated and 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 is needed is anticoagulant plus dual antiplatelet therapy, the latter is abbreviated as DAPT in English.
Why not use it at this stage? Because the other type of antiplatelet drug used in DAPT is not a thromboxane A2 (TXA2) inhibitor such as aspirin.
