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Aspirin and ibuprofen are both well-known antipyretic analgesics, which can reduce low temperature and relieve various pains such as headaches, toothaches, joint pain, dysmenorrhea, etc., but aspirin also has an effect that ibuprofen cannot replace, that is, to prevent thrombosis. Clinically, patients after myocardial infarction and cerebral infarction often use aspirin to prevent postoperative thrombosis.
In 2019, 64-year-old Yu Guoqiang was woken up by a faint tingling pain in his chest, and when he saw that the time was only 3 o'clock in the morning, he rubbed his chest and tried to fall asleep, but there was always a suffocating breath blocked in his body, and his heart was also very panicked, like hundreds of ants crawling on his heart, Yu Guoqiang hated to reach in and grab it. He just tossed and turned and tried to kick this feeling away, but it didn't ease until his wife next to him was woken up by him.
The sunlight gradually penetrated the room, and the pain in my chest did not get better for 4 hours, but gradually changed from a stinging pain to a pain like being squeezed, and my breathing gradually became short, and the whole person curled up in a ball. Only then did his wife notice that something was wrong with Yu Guoqiang, and when she saw him sweating, she immediately dialed 120.
After listening to his description of symptoms, the doctor immediately performed an electrocardiogram for Yu Guoqiang, and the results suggested: sinus bradycardia, complete right bundle branch block, and T-wave changes. At the same time, a blood test was taken to check troponin T986.0pg/ml, which was completely consistent with the evolution of acute myocardial infarction.
Complete right bundle branch block is commonly associated with various heart diseases with altered heart structures, such as hypertensive heart disease, atherosclerotic coronary heart disease, myocarditis, cardiomyopathy, etc. Troponin T exists in cardiomyocytes, and the content in the blood of ordinary people will not exceed 14pg/ml.
The doctor recommended that Yu Guoqiang undergo a coronary angiography examination, which is not only a test, but also a surgical treatment. The doctor uses a guidewire with an exploration function to enter the heart blood vessels along the radial artery on the wrist, which can clearly see the situation inside the blood vessels, evaluate the degree of blockage of the blood vessels, and when the blood vessels are blocked by more than 70%, they can directly implant a stent to dredge the blood vessels.
During the exploration, the doctor found that Yu Guoqiang's left circumflex branch was occluded, and the left anterior descending artery was bifurcated and stenotic by 50-70%, which had reached the standard of clinical stent implantation, so he was sent into the stent with the guidewire and placed in the left circumflex and left anterior descending artery. After waking up from the anesthetic, Yu Guoqiang only felt a slight pain in his wrist, while the tightness and pain in his chest had been half better, and he no longer felt flustered when he slept at night.
At the time of discharge, the doctor prescribed isosorbide mononitrate tablets, aspirin enteric-coated tablets, and rabeprazole for Yu Guoqiang, and instructed Yu Guoqiang to go to the cardiology outpatient clinic for follow-up 1 month, 6 months, and 12 months after discharge, and recheck the coronary angiography one year later. The discharge summary states in detail how to take each drug, and aspirin needs to be taken for a long time.
Patients who have undergone a myocardial infarction take aspirin to prevent postoperative thrombosis. Platelets are an important part of the blood involved in the coagulation process, when the platelets in the blood of patients after myocardial infarction are highly activated, it will accelerate the formation of thrombosis, and aspirin can inhibit the aggregation of platelets, so it is often used in clinical practice for the prevention of postoperative thrombosis.
However, long-term use of aspirin to inhibit the clotting process can also lead to coagulation disorders in people who take the drug, which is manifested as easy bleeding or prolonged hemostasis. There may be some bruising spots, ecchymosis, or repeated bleeding gums and nosebleeds on the surface of the skin, which may cause cerebral hemorrhage or stroke, so doctors will always remind people who take aspirin for a long time to pay attention to the symptoms and changes in the body, and regularly review the coagulation function.
Yu Guoqiang still had palpitations about the near-death experience that almost arrived that morning, and he didn't dare to delay taking the medicine after returning home, so he took the medicine diligently every day, and followed the doctor's instructions to undergo re-examinations at 1 month, 3 months, and 12 months after discharge, and the results of the re-examination of coronary angiography at 12 months showed that the blood flow through the blood vessels was good, so he was relieved.
In June 2022, when Yu Guoqiang was flushing, he saw that the color of his stool was very strange, just like the color of black briquettes, and he thought that he had recently heard that black beans can prevent heart disease and ate them for three days in a row, which should be the reason, so he didn't take it to heart.
On July 9th, Yu Guoqiang always felt dizzy recently, on this day, the light bulb in the storage room was broken, his wife was holding the ladder on the side, Yu Guoqiang tilted his head and installed the light bulb, just when his left foot landed on the second staircase, he suddenly felt that the entire storage room was spinning, and he fell from the ladder suddenly in front of him. Fortunately, there were discarded mattresses on the floor, so Yu Guoqiang didn't hurt his bones and head, but this time it really frightened the couple and ran directly to the hospital.
The blood routine showed that Yu Guoqiang's hemoglobin was only 86g, which belonged to moderate anemia, and there was 3+ occult blood in the stool. Gastroscopy showed bleeding from Guoqiang's duodenal ulcer and superficial gastritis with erosion. It turned out that Yu Guoqiang was anemia and dizziness due to stomach bleeding, and black stool was also caused by gastrointestinal bleeding.
After the doctor asked Yu Guoqiang about his living habits, illness and medication history, he found that the thief still had an upper line, and this upper line was aspirin. After hearing this, Yu Guoqiang and his wife were full of question marks, obviously it was the medicine prescribed by the same hospital, why did they still have stomach problems? The doctor looked at Yu Guoqiang's previous medical records, and he was also puzzled, obviously the medicine prescribed was correct, and many patients also took it like this, but why did Yu Guoqiang have stomach ulcer bleeding?
The doctor asked Yu Guoqiang about his medication habits in detail, and after hearing Yu Guoqiang's answer, he suddenly said: "Patients after myocardial infarction do need to take aspirin for a long time, and most patients will not have any problems, while some patients will have gastric ulcer bleeding like you, and if you don't pay attention to it, it will lead to gastric bleeding and life-threatening! ”
In addition to inhibiting platelet aggregation, aspirin can also damage the gastric mucosa, so doctors often use gastric protection drugs in combination to prevent damage to the gastric mucosa during taking aspirin. When he was discharged from the hospital, the doctor prescribed rabeprazole enteric-coated tablets for Yu Guoqiang, which is a stomach protection drug, which is often used for the treatment of gastric ulcers and the prevention of aspirin gastric ulcers.
However, there is an important note when taking rabeprazole that it should not be chewed or crushed, and it should be swallowed whole. This is because rabeprazole has a layer of casing on the surface, which is insoluble in acidic gastric juice, but soluble in alkaline gastric juice, and it acts as the armor of rabeprazole, escorting rabeprazole intact into the intestine and being absorbed by the intestinal mucosa.
However, Yu Guoqiang often divides a tablet into two when taking rabeprazole, which causes the casing of rabeprazole to lose its effect, and it is decomposed by gastric acid and other substances in the stomach in advance on the way to the intestines, resulting in the loss of drug effect, which cannot prevent gastric ulcers that may be caused by aspirin.
Rabeprazole should not be taken after a meal and should be taken on an empty stomach or 30 minutes before a meal. This is because taking rabeprazole after a full meal will cause the pill to stay in the stomach for too long under the coercion of various foods, resulting in decomposition, and will also lose enteric effect, and will also increase rabeprazole's irritation to the stomach and produce toxic side effects such as stomach flatulence, allergies, nausea, diarrhea, etc.
Yu Guoqiang sometimes can't grasp the time 30 minutes before the meal, and often forgets to take the medicine, so he makes up the amount of medicine after the meal, but this behavior will lead to the same as taking the medicine and not taking it. In the long run, the damaging effect of aspirin on the stomach cannot be suppressed, which can lead to gastric ulcers.