Famous Among Top Surgeons in the 90s

Student Pan listed the key points of knowledge, and the other students nodded frequently.

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

As a patient after PCI surgery, it is essential to take Warfarin-type anticoagulants long-term according to the doctor's advice, with the aim of preventing in-stent thrombosis. In-stent thrombosis is more fatal than in-stent restenosis, as an acute myocardial infarction caused by thrombosis can lead to a mortality rate of twenty to forty percent.

Using only anticoagulants is not enough; doctors often prescribe aspirin as an antiplatelet treatment for patients. Aspirin is the most widely used antiplatelet drug in clinical practice, belonging to the thromboxane A2 (TXA2) inhibitors.

A layperson might find it strange and wonder why anticoagulants alone are not sufficient and why there is a need for antiplatelet drugs. Aren't they both antithrombotic? There are three types of antithrombotic drugs: apart from the two mentioned above, the other type is the most direct one, called thrombolytic drugs. In the early days, without drug-eluting stents covered by medical insurance, thrombolytic drugs were often used in clinical practice for saving patients with acute myocardial infarction. Thrombolytic drugs are equally expensive, but they are cheaper than stent or bypass surgeries. Considering the technical essentials, you can understand where the cost savings come from: no surgery is needed, and the technical requirements for hospitals and doctors are lower, allowing medium and small hospitals to carry it out, whereas the former must be done in large hospitals.

Common folks have no choice when they are poor.

Doctors in large hospitals aren't fond of thrombolytic drugs because their use must be timely; it's best to use them within three hours of the myocardial infarction, or else the efficacy is greatly reduced or ineffective. Moreover, thrombolytic drugs are ineffective against stubborn thrombosis, meaning even after thrombolysis, angiography and additional stent placement may be necessary. Also, the drugs affect the whole body, unlike localized surgery, and the complications from thrombolytic therapy can be terrifying. Many patients with underlying diseases must use them cautiously, and elderly people with multiple systemic conditions are contraindicated. Yet, the issue is that many elderly people also suffer from heart attacks.

Those with a bit of money and convinced by doctors will immediately eliminate thrombolytic therapy and drugs. They undergo surgery and use the other two types of antithrombotic drugs post-operatively in combination for better results.

Don't be fooled that anticoagulants and antiplatelet drugs, although both are antithrombotic, work similarly to thrombolytics. They are indeed two categories with completely different mechanisms of action. Whether physiological hemostasis or abnormal thrombosis occurs in people, it's essentially the processes of platelet aggregation and coagulation. The former's main players are platelets, which rush to adhere to the vessel walls for hemostasis or clot formation. The latter's crucial players are coagulation factors, which, upon receiving the signal of vascular damage, are activated from a quiet state and convert soluble fibrinogen into insoluble fibrin, forming a fibrin network that traps blood cells to become a blood clot.

According to this principle, antiplatelet drugs are researched to drive away platelets, preventing their aggregation and adhesion. Anticoagulants, on the other hand, are to prevent the activation and conversion of coagulation factors.

Xie Wanying learned before reincarnation that for effective post-PCI thrombosis prevention, using just Warfarin and aspirin is not strong enough. What is needed is anticoagulant plus dual antiplatelet therapy, abbreviated as DAPT in English.

Why not use it at the current stage? Because the other class of antiplatelet drugs used in DAPT is not thromboxane A2 (TXA2) inhibitors like aspirin.