Aspirin and clopidogrel are commonly used as antiplatelet agents in coronary artery disease. Clinical studies have shown that antiplatelet therapy can reduce the incidence of major cardiovascular events by about 23% and reduce the rate of post-stent or post-bypass occlusion and restenosis by about 45%, making them the cornerstone drugs in the treatment of coronary artery disease. In recent communication with coronary heart disease patients, most of them have doubts about when to take aspirin and clopidogrel at the same time and when to take only one, which one is more effective? So, let’s talk about how antiplatelet drugs should be used. Why do antiplatelet drugs prevent thrombosis? Blood clots are formed by a combination of components such as clotting factors, fibrin and platelets. In normal blood circulation, platelets are inactive. When the endothelium is deformed or destroyed, platelets change from a resting state to a functional state, a process called platelet activation. Cardiovascular diseases lead to endothelial injury of blood vessels, which exposes the formation of a “platelet membrane” in the subendothelial injury, and through the induction of ADP (clopidogrel inhibits ADP-mediated), thromboxane (aspirin inhibits thromboxane production) and other in vivo factors to change the platelet surface configuration, followed by platelet aggregation, activation and aggregation of platelets can Further activation of coagulation factors, fibrinogen, etc., leads to the formation of thrombus. Antiplatelet drugs such as aspirin or (and) clopidogrel can block the process of thrombosis, and therefore become the cornerstone drugs in the treatment of coronary artery disease. When do I need to take aspirin and clopidogrel together? Since aspirin and clopidogrel act as antiplatelet agents through different mechanisms, sometimes the combination is needed to enhance the antiplatelet effect. 2016 ACC/AHA guidelines clearly indicate that patients with acute coronary syndromes (including acute ST-segment elevation myocardial infarction, acute non-ST-segment elevation myocardial infarction, and unstable angina), post-stenting, and post-bypass need to take dual antiplatelet agents for 6 to 12 months of dual antiplatelet therapy. Discontinuation of dual antiplatelet therapy requires strict compliance with medical advice. Because the stent is not completely covered by the endothelium and attached to the vessel wall after the stent is placed, failure to adhere to dual antiplatelet drugs may lead to re-embolism. Since the time to discontinue dual antiplatelet drugs varies from person to person depending on the type of stent implanted and the severity of the patient’s condition, it is important to follow up regularly and let the specialist decide whether you should discontinue the drug. When should I use aspirin or clopidogrel alone? How should I choose? Antiplatelet therapy with aspirin or clopidogrel is the cornerstone of secondary prevention of thrombotic disease such as ischemic stroke or coronary artery disease. The main objectives are to reduce the rate of platelet aggregation, prevent and control thrombosis, and improve prognosis. Advantages of aspirin: cheap, the earliest drug discovered for antiplatelet, well-documented data from evidence-based medical trials, and definite effectiveness. Disadvantages: easy to cause gastrointestinal damage, gastrointestinal bleeding and other side effects. Advantages of clopidogrel: metabolized by the liver, less damage to the gastrointestinal tract. Disadvantages: Individual genetic differences affect this drug too much, and the treatment effect is highly variable. In general, aspirin is preferred, and if there is gastrointestinal disease, PPI and other drugs to protect the gastric mucosa can be added, or clopidogrel can be used instead as an antiplatelet. In addition, antiplatelet drugs may be aspirin-resistant (taking aspirin with ineffective antiplatelet effect) and clopidogrel-resistant (taking clopidogrel with ineffective antiplatelet effect) patients depending on the patient’s own metabolism, genetic inheritance, number of receptors, etc. To get a good treatment effect, it is recommended to test the effect of drugs on platelet aggregation rate. Stable coronary patients can be tested by turbidimetric method, which is less expensive, and patients with severe coronary disease can be tested by thromboelastography method, which is more accurate. How are the new antiplatelet drugs treated? Tegretol: same mechanism of action as clopidogrel, direct active drug, no liver metabolism required. 2016 ACC/AHA guidelines indicate that tegretol can be used to replace clopidogrel when needed, and foreign experiments also prove this effect is better than clopidogrel. However, these new drugs are not widely available in China, mainly because they are expensive and there are few experimental data on their clinical effects in domestic patients with coronary artery disease, and further studies are needed. At present, there are still various problems with antiplatelet drugs, and how to effectively inhibit thrombosis while reducing the risk of bleeding is a difficult problem in the treatment of cardiovascular thrombotic diseases. In Prof. Shi Dazhuo’s team, a subject in which I participated, the study proved that the combination of Chinese herbal tonics formulated by the method of benefitting Qi and invigorating blood with antiplatelet drugs for coronary heart disease can increase the anti-thrombotic effect and reduce the occurrence of gastrointestinal diseases, so coronary patients can take the tonics to assist in the treatment with confidence, which is beneficial to your disease. See here is not feel too much content, as a coronary heart disease of middle-aged and elderly patients simply can not remember so much content. This is right, how to take anti-platelet drugs, or let the expert doctors to study it. It is advisable for you to have regular follow-ups and get a specialist to help you adjust your medication according to your condition is the best treatment for you!