In June this year, I saw an article in the "Chinese Circulation Magazine", entitled "Secondary Prevention of Coronary Heart Disease, Aspirin Defeats!".》。It mainly describes the comparative trial of aspirin for the possible use of secondary prevention of coronary heart disease, and the results of aspirin performance are a bit unsatisfactory.
1. What is secondary prevention in patients with coronary heart disease?
The so-called secondary prevention refers to the fact that coronary heart disease has been suffered, and we need to carry out drugs and other drugs to prevent the recurrence of cardiovascular events. In layman's terms, after the diagnosis of coronary heart disease, long-term oral drugs are needed to avoid the disease and aggravation. Specific to today's article, secondary prevention is to take aspirin for long-term ** after being diagnosed with coronary heart disease to avoid the recurrence or aggravation of coronary heart disease.
Second, secondary prevention, why use aspirin?
Aspirin has always been the top priority for secondary prevention of coronary heart disease. Because aspirin can bind to platelets, it inhibits platelet aggregation and reduces cardiovascular events. In fact, aspirin is just an antiplatelet drug that we often hear about, in addition to aspirin, there are also P2Y12 inhibitors are common antiplatelet drugs other than aspirin, mainly including clopidogrel and ticagrelor. Aspirin is a long-established antiplatelet drug because of the abundant evidence and the current guideline recommendation of the drug of choice.
3. The new results break the aspirin myth?
A total of seven randomized trials involving a total of 24,325 patients with stable coronary artery disease were included in this meta-analysis. These patients were randomly assigned to a P2Y12 inhibitor group and an aspirin group. On average 1At 35 years of follow-up, patients treated with P2Y12 inhibitors had a 12% lower risk of the composite endpoint of cardiovascular death, myocardial infarction, and stroke than those who took aspirin. In simple terms, patients who take hydroclopidogrel or ticagrelor have better results than aspirin.
Fourth, in addition to reducing the risk, it also reduces complications
The article noted that there was no difference in the risk of major bleeding, stroke, or cardiovascular death between the P2Y12 inhibitor and aspirin groups. However, the P2Y12 inhibitor group had a reduced risk of gastrointestinal bleeding, definite stent thrombosis, and hemorrhagic stroke, respectively. This suggests that P2Y12 inhibitors are associated with a lower risk of gastrointestinal bleeding and stent thrombosis. In layman's terms, it is better to use hydroclopidogrel or ticagrelor.
The data from this study challenge the centrality of aspirin in secondary prevention and support the use of P2Y12 inhibitors alone as a long-term secondary prevention in patients with coronary artery disease. In fact, after reading this article, I have become more inclined to use hydroclopidogrel for long-term antiplatelet resistance in patients with secondary prevention of coronary heart disease**.
On the one hand, it benefits more than aspirin, on the other hand, the ** of hydroclopidogrel is also significantly reduced, and the third aspect is that the once-daily way of taking it makes ticagrelor have no advantage.
It seems that doctors also need to keep up with the times!
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