This is a patient I met not long ago.
An old man whose coronary arteries have been stented for several years is in his 70s.
It is said that in recent days, when walking and moving, there is chest tightness and discomfort, and it is good to stop and rest for a while.
Ask him if he didn't look like the situation before the original bracket was not placed, saying that it was a bit like, not so heavy.
Is this the coronary artery narrowing again? Or is there a new lesion? Do you want to do coronary CT or contrast again?
Q: What medicine are you taking now?
A: Statin eats, isosorbide mononitrate eats, small doses of betalak (metoprolol) also eats, and also eats compound salvia tablets.
Q: What about aspirin or clopidogrel?
A: Originally I was eating aspirin, but then people said it was bad for the stomach, so I stopped. I heard that danshen tablets can invigorate blood and replace the role of aspirin, so I ate compound danshen tablets.
Q: How long has aspirin stopped?
A: It's been almost two weeks.
Well, it should be a "pass" to stop aspirin.
Then quickly eat aspirin, and then adjust the nitrate drug to observe.
Aspirin, eaten in small doses, 75 mg to 150 mg per day, plays an antiplatelet effect, as an antiplatelet drug.
Why should patients with coronary heart take antiplatelet drugs? Because the platelets of coronary heart patients are "active", the blood vessels are "inflammatory" and irritated; also because there are plaques on the blood vessel wall of coronary heart patients, uneven and uneven, and it is easy to "hang" platelets; and then because the plaques in the coronary veins of coronary heart patients are easy to rupture and bleed. Platelets are active, that is, active and easy to condense; easy to hang on the blood vessel wall, that is, easy to attach to the formation of blood clots; plaque rupture and bleeding is to grow thrombosis, which are the reasons why coronary heart patients are prone to blood clots in the arterial vessels. Once a blood clot grows, the original narrow blood vessels are blocked, the myocardium is ischemia, necrosis, angina, myocardial infarction.
Therefore, a very important one in the treatment of coronary heart disease is antiplatelets. Usually use one drug, aspirin or clopidogrel; if the platelets are too active and the risk of thrombosis is too high, two antiplatelet drugs should be used, such as unstable angina, after the stent, with aspirin plus clopidogrel or ticagrelor.
However, this old gentleman stopped an antiplatelet drug, can not be sick!
Some people will ask, why did I stop the drug at that time and did not get sick, and now it took about 10 days to get sick?
This is related to the metabolism and excretion of drugs. Aspirin this drug, eating it every day inhibits about 10% to 15% of platelets in the body, so that eating for 1 week to 10 days (some people may take 2 weeks) will inhibit the platelets in the body and play an anti-thrombotic effect. The same is true when the drug is stopped, the drug is stopped for about 1 week to 10 days, the effect of the drug is completely gone, the platelets are active again, and the angina is about to be committed.
Just like this patient, about 10 days after stopping the drug, the onset of the disease is just right.
Some people will ask, didn't the patient eat danshen tablets? Can't salvia tablets replace aspirin?
Danshen tablets can't replace aspirin! At least for now.
Aspirin, the antiplatelet mechanism of action has been studied very clearly. In what part of the platelets work, how much and how long to use, what side effects, how to take, etc., not only to study pharmacology, but also clinical trials, many people have eaten for many years of efficacy and safety research, confirmed the determined effect.
In fact, this patient has been taking the drug for many years, the condition is stable, and there is no obvious adverse reaction, indicating that he can tolerate the drug and can continue to take it.
What about compound salvia tablets? Salvia itself has the effect of activating blood and dissolving stasis, and studies have also found that the main component of danshen, danphenolic acid B, has the effect of inhibiting platelet aggregation. But the research is not sufficient. How much content these ingredients can be in tablets, how much role they can play, etc. have not been well studied, and there is a lack of large-scale clinical trial studies to confirm efficacy and safety, in medical terms, that is, there is no evidence of evidence-based medicine to prove effective. Therefore, at present, it can only be used as an adjunctive drug, and cannot replace aspirin for antiplatelet therapy after coronary heart disease and coronary stenting.
Another point should also be reminded that compound danshen tablets contain ice chips, ice chips can also stimulate and damage the gastric mucosa, and in severe cases, it can also cause gastric mucosal ulcers, so it is not so safe.
Therefore, the following treatment has been done.
* Instruct the patient to resume oral aspirin. Because there are clear and effective therapeutic drugs, if doctors do not give patients to use drugs that are uncertain of efficacy and safety, it is also not in line with medical ethics. Therefore, for patients with coronary heart disease and coronary stent surgery, there is a standardized treatment plan, and the patient has no adverse reactions, or insist on medication.
* Nitrate drugs are adjusted like this: temporarily change the isosorbide mononitrate extended-release tablets to isosorbide mononitrate tablets (heartache), short-term effect, faster onset, 3 to 4 times a day, the dose is easy to adjust, and clinical use is not easy to resist. After the control is stable, it is changed to a long-acting extended-release preparation.
* Instruct the patient to continue to take the drug in a stable condition, and follow up in time if the control is not good.
(All rights reserved, may not be reproduced without my authorization!) ）