Patient Question: Disease: Coronary heart disease Description: Had a heart stent for coronary heart disease ten days ago, taking Bolivar and aspirin, recently failed a thromboelastogram, what are the side effects if I switch to Tegretol? The patient is 68 years old, female, with diabetes. Is it appropriate to add cilostazol with poliovir and aspirin? Help wanted: Please ask your doctor to give me some advice on treatment. Response: Tigretol is a direct-acting P2Y12 receptor antagonist that does not require cytochrome metabolic activation, whereas clopidogrel is a precursor drug, thus tigretol has a more rapid and potent platelet inhibitory capacity. Domestic and international guidelines do list tigretol and prasugrel at a higher recommendation level than clopidogrel. However, it should be clear that thromboelastography itself is not fully recognized by experts in the field, and no academic institution has published guidelines that use thromboelastography as the gold standard for testing platelet function, so I personally have doubts about its guiding significance. In addition, tigretol is not a miracle drug, the main adverse effect of tigretol is dyspnea, besides, its antiplatelet activity is stronger and longer than clopidogrel, which brings the risk of bleeding, therefore, it is necessary to be cautious when changing the drug. Moreover, tigretol is not yet listed as a reimbursable drug in Beijing health insurance, so if you change the drug, the out-of-pocket cost of the drug has to be considered. Of course, it is important to keep in mind that the dual antiplatelet therapy must be more than one year old. Patient Question: Thank you, Dr. Ken, for your detailed guidance. Do I still need to take cilostazol if I don’t change my medication? Also, how soon after surgery would it be better to follow up with the patient with such indicators? I look forward to your guidance! Response: Anti-platelet therapy is the most important treatment after stenting, just because the current platelet function testing technology is immature, so no single test result can perfectly predict the clinical prognosis. For the postoperative treatment plan, it must be individualized with your risk factors, blood pressure, lipid and blood glucose, coronary artery, number of stents, stent sites, residual lesions, intraoperative conditions, etc. Only your surgeon knows your situation best, and therefore your surgeon is responsible for the specific formulation of the postoperative treatment plan. Usually, our escalation plan for high-risk patients is to change from aspirin + clopidogrel dose to aspirin + clopidogrel + cilostazol dose or aspirin + tigretol dose. The cost of the triplet is cheaper, after all, health insurance can pay for most of it, while the cost of tigretol is a bit high at close to $30 per day. The program is for reference only, and everything is subject to the surgeon’s plan.