In the cardiovascular department of the hospital, an old man with silver hair and a kind face slowly walked into the director's office. He clutched a prescription in his hand, his brow furrowed, and he seemed to be full of preoccupations. The old man, surnamed Li, is a "frequent visitor" of the hospital, and is quite familiar with the doctors here because he has suffered from cardiovascular and cerebrovascular diseases for many years.
"Director Zhao, I have something on my mind, and I want to talk to you." As soon as Old Man Li spoke, there was a little anxiety in his voice.
Director Zhao, an experienced and skilled cardiovascular specialist, put down the medical records in his hand and smiled and motioned for Mr. Li to sit down. "Elder Li, what's wrong with you being so worried? Let's figure it out. ”
"That's right, Director Zhao." Old Man Li handed the prescription to Director Zhao, "I have been following your instructions and taking aspirin to prevent cerebral infarction. But this medicine is really not friendly to my stomach, and my stomach hurts uncomfortably every day. I heard that clopidogrel is less irritating to the stomach, can I change it to that medicine? ”
Director Zhao took the prescription, looked at it carefully, and then looked up at Old Man Li, with a bit of thought in his eyes. "Old Li, the matter of changing the medicine is not something that can be changed casually, you have to pay attention to a scientific reason. In this way, I will first test Dr. Xiao Zhang in our department to see how much he knows about these two drugs, and then give you a clear answer. ”
As he spoke, Director Zhao pressed the call bell on the table, and after a while, a young and handsome doctor walked in, it was Xiao Zhang.
"Xiao Zhang, you came just in time. Old man Li has a question here, he wants to change aspirin to clopidogrel, what do you think? Director Zhao directly threw the question to Xiao Zhang.
When Dr. Zhang heard this, he was slightly stunned, then quickly sorted out his thoughts and began to answer: "Director Zhao, aspirin and clopidogrel are both antiplatelet aggregation drugs used to prevent cardiovascular and cerebrovascular diseases. However, aspirin does have a certain irritating effect on the gastric mucosa, while clopidogrel is relatively mild. However, there are a few key points that we need to consider before switching dressings. ”
"Well, that's good. So tell me, what are the key points that need to be paid attention to? Director Zhao nodded with satisfaction and encouraged Xiao Zhang to continue.
Dr. Zhang cleared his throat and began to explain in detail: "First of all, we need to understand the specific situation of the patient. Does Mr. Li have a history of stomach ulcers? Or other gastrointestinal issues? If anything, aspirin does require caution when using it. However, even if you switch to clopidogrel, it is not completely risk-free. Because clopidogrel, although less irritating to the gastrointestinal tract, may also increase the risk of gastrointestinal bleeding. ”
"Well said, Xiao Zhang. Do you know why aspirin causes stomach pain, stomach ulcers, or stomach bleeding? Director Zhao asked further questions.
Dr. Zhang thought for a moment and replied, "This is mainly because after aspirin is broken down in the stomach, it will release salicylic acid, an acidic substance, which directly stimulates the gastric mucosa. At the same time, aspirin also inhibits the action of prostaglandins, leading to the loss of the protective effect of the gastric mucosa. In addition, even after the intestine is absorbed into the bloodstream, aspirin will return to the stomach with blood circulation, causing new irritation to the gastric mucosa. ”
"It's comprehensive, Zhang. So how much do you know about clopidogrel? For example, its metabolic processes, interactions with other drugs, etc. Director Zhao continued to question.
Dr. Zhang smiled slightly, obviously prepared for this question: "Clopidogrel is a prodrug that needs to go through a two-step oxidation reaction in the liver to become an active substance. Genetic CYP2C19 plays a key role in this process. Therefore, before using clopidogrel, we need to check that the patient is carrying a CYP2C19 gene key that unlocks the effects of the drug. If it is not carried, then taking clopidogrel is often ineffective. ”
"Very good, Xiao Zhang. Do you still know what drugs clopidogrel can't be used with at the same time? Director Zhao continued to ask.
"I know that." Dr. Zhang quickly replied, "Clopidogrel cannot be used at the same time as proton pump inhibitors (PPIs) such as omeprazole, as they compete for the same metabolic pathway, resulting in a decrease in the concentration of active metabolites of clopidogrel. However, PPI drugs such as pantoprazole, rabeprazole, and lansoprazole can coexist peacefully with clopidogrel. ”
"Not bad, not bad." Director Zhao nodded again and again, "Then do you know what diabetics need to pay attention to when using clopidogrel?" ”
Dr. Zhang thought for a moment and replied, "If diabetic patients are still using hypoglycemic drugs such as repaglinide, then they need to be especially careful when using clopidogrel. Because the metabolites of clopidogrel inhibit repaglinide's metabolic enzymes, causing repaglinide to accumulate in the body, increasing the risk of hypoglycemia. In this case, switching clopidogrel to ticagrelor or adjusting repaglinide to nateglinide or miciglinide may be considered. ”
"Very good, Xiao Zhang. You answered very comprehensively. Director Zhao looked at Dr. Xiao Zhang approvingly, "Now, you can give Old Man Li a clear answer." ”
Doctor Xiao Zhang turned to Old Man Li and said seriously, "Old Man Li, depending on your situation, we can consider changing aspirin to clopidogrel. However, before you change the dressing, we need to do some tests to make sure you have the CYP2C19 gene key that turns on clopidogrel. At the same time, if you experience any discomfort during the use of clopidogrel, such as stomach pain, bleeding gums, bruising skin, blood in the stool, etc., you must come to the hospital in time. ”
Old Man Li listened to Dr. Xiao Zhang's explanation, and his brows gradually relaxed. "I see, Dr. Zhang, thank you for explaining it to me so clearly. Then I'm going to go for a test and see if I can change the medicine. ”
"Okay, Old Man Li. You can rest assured that we will always monitor your situation to ensure that your treatment is safe and effective. Dr. Zhang smiled and sent Old Man Li away.
Director Zhao looked at Dr. Xiao Zhang's back, and his heart was full of relief. He knew that this young doctor had grown into the backbone of the department and would be able to take charge of himself in the future.
A few days later, the results of Old Man Li's examination came out. He did carry the CYP2C19 gene key that unlocked clopidogrel's effects. So, under the guidance of Director Zhao and Dr. Xiao Zhang, Mr. Li successfully replaced aspirin with clopidogrel.
After changing the dressing, Mr. Li's stomach pain symptoms were significantly reduced, and his mental state was much better. He came to the hospital to express his gratitude to Director Zhao and Dr. Xiao Zhang: "Thank you so much! I feel much better now and don't have to worry about stomach pain anymore. ”
Director Zhao and Dr. Xiao Zhang looked at each other and smiled, their hearts full of a sense of accomplishment. They know that this is the greatest happiness of doctors – to be able to help patients relieve their pain and return to a healthy life.
Through this experience, Mr. Li also gained a deeper understanding of the two drugs, aspirin and clopidogrel. He realized that before using any medication, he needed to be fully aware of its side effects and precautions to ensure that his treatment was safe and effective. At the same time, he trusts the doctors and nurses at the hospital even more, as they are always able to answer his every question with professional knowledge and patience.