Returning to ’90s, She Became Famous in Major Surgical Fields

  Yue Wentong did not deny: "The patient is taking warfarin."

  As a patient after PCI, according to the doctor\'s advice, he should take warfarin-type anticoagulant for a long time, in order to prevent the formation of stent thrombosis. In-stent thrombosis is more deadly than in-stent restenosis. Acute myocardial infarction caused by the thrombosis segment will cause the mortality rate to reach 20 to 40%.

   Anticoagulants alone are not enough, and doctors often prescribe aspirin as antiplatelet therapy to patients. Aspirin is the most widely used antiplatelet drug in clinical practice and belongs to the thromboxane A2 (TXA2) inhibitor.

  A layman may find it strange to hear that mono anticoagulant is not enough, why should we add any antiplatelet drug? Aren\'t they all the same as antithrombotic? There are three kinds of antithrombotic drugs. In addition to the above two, the other is the most direct, called thrombolytic drugs. In fact, when there is no drug stent in the early stage and the bare stent is not reimbursed by medical insurance, it is a commonly used treatment plan for the clinical rescue of patients with acute myocardial infarction. Thrombolytics are just as expensive, just cheaper than stenting and bypass surgery. If you think about its technical essentials, you will know where it is cheaper. No surgery is required, and the technical requirements for hospitals and doctors are low. It can be carried out in small and medium-sized hospitals. The former must be carried out in large hospitals.

   The poor have no choice.

   Thrombolytic drugs are not liked by doctors in large hospitals, because the use of thrombolytic drugs must pay attention to timing, 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 for refractory thrombus, which means that even if thrombolysis is completed, angiography must be done before stenting. Moreover, the medicine affects the whole body, unlike the operation limited to the local body, the complications caused by thrombolytic therapy will be terrible. Many patients with underlying diseases must be used with caution, and the elderly with various systemic diseases are contraindicated. There are also more heart attacks in the elderly.

   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.

   Anticoagulants and antiplatelet drugs don’t look like they are both antithrombotics. They seem to be similar to thrombolysis, but they are really two types of drugs with completely different mechanisms of action. Whether it is physiological hemostasis or abnormal thrombosis, there are actually two processes of platelet aggregation and coagulation. The protagonist of the former is platelets, platelets run to a piece to adhere to the blood vessel wall to stop bleeding or form a thrombus. The important role of the latter is a coagulation factor, which is activated from a resting state upon receiving a signal of blood vessel damage, which promotes fibrin from soluble to insoluble, and pulls blood cells into a fibrin network network into blood clots.

  According to this principle, the antiplatelet drugs that have been developed should drive away platelets and prevent them from releasing aggregation and adhesion. Anticoagulants prevent coagulation factors from being activated and not transformed.

  What Xie Wanying knew before and after her rebirth was that warfarin and aspirin were not enough to make patients after PCI truly antithrombotic. What is needed is anticoagulant plus dual antiplatelet therapy, which is abbreviated as DAPT in English.

  Why not use it at this stage? Because another class of antiplatelet drugs used in DAPT is not a thromboxane A2 (TXA2) inhibitor like aspirin.

   (end of this chapter)