A friend left a message asking Huazi about the differences in the pharmacological mechanisms of the three drugs, aspirin, clopidogrel and indobufen, and what are the advantages and disadvantages of each. How to determine which one is suitable for me?

Hua Zi said that these three drugs are commonly used antiplatelet drugs, and their effects are basically the same. They can inhibit platelet aggregation and prevent arterial thrombosis. They are mainly used to prevent myocardial infarction and cerebral infarction. The differences between the three are mainly in adverse reactions, duration of action, and interactions with other drugs.

1. Aspirin

Irreversibly inhibits cyclooxygenase (COX1, COX2) in platelets , reduces the production of thromboxane A2, and inhibits platelet aggregation. Its main features are long time on the market, low price and sufficient clinical evidence.

The main adverse reaction of aspirin is that long-term use will increase the risk of gastrointestinal damage , may induce asthma, and increase the risk of bleeding.

Aspirin is mainly used to prevent coronary heart disease, myocardial infarction, stroke, and peripheral arterial disease. It is the most widely used clinically and is the first choice for antiplatelet therapy.

2. Clopidogrel

Irreversibly inhibits the P2Y12 receptor in platelets and inhibits platelet aggregation. After oral administration, it needs to be metabolized by liver enzymes to release active products and exert its effects. Due to genetic polymorphism, a small number of people have low enzyme activity , which may affect the antiplatelet effect of clopidogrel.

Omeprazole and esomeprazole in proton pump inhibitors will compete with the metabolic enzymes of clopidogrel, affecting its antiplatelet effect. Please note that they cannot be used in combination .

Clopidogrel has no direct irritation to the digestive tract and the risk of digestive tract damage is weaker, but the risk of bleeding is similar to that of aspirin.

Clopidogrel is mainly used for acute coronary syndrome or in combination with aspirin for "dual-antibody" treatment after stent placement. For those who are intolerant to aspirin, clopidogrel can be used as a substitute.

3. Indobufen

It reversibly inhibits cyclooxygenase (COX1) in platelets , and inhibits adenosine diphosphate, inhibiting platelet aggregation. Its characteristic is that the inhibition of platelets is reversible , and platelet function can be restored within 24 hours after stopping the drug.

Indobufen has good gastrointestinal tolerance, a low risk of bleeding, and good overall safety.

Because indobufen has reversible platelet inhibition, the drug effect can be flexibly adjusted, but there is little experience in its application in China and limited data on its long-term safety . According to European guidelines, it can be used for the prevention of atherosclerotic thrombosis, but in China it is more often used for perioperative antiplatelet replacement therapy.

Application of three drugs

Antiplatelet therapy requires long-term or even lifelong medication. Aspirin and clopidogrel have irreversible platelet inhibition , and taking the drug once a day can maintain its efficacy. Occasional missed doses have little effect on the efficacy. Indobufen has reversible platelet inhibition , and the drug needs to be taken twice a day . Missing a dose will increase the risk of thrombosis.

When taking medication for a long time, aspirin is usually the first choice . If it cannot be tolerated or there are contraindications, clopidogrel can be used instead of aspirin. If clopidogrel is not effective due to genetic polymorphism, ticagrelor can be considered instead of clopidogrel.

Indobufen can be used if you have severe gastrointestinal diseases or a high risk of bleeding or have had surgery recently, but be careful not to miss doses.

In summary, aspirin, clopidogrel and indobufen have similar effects. Aspirin and clopidogrel have irreversible inhibition of platelets, while indobufen has reversible inhibition of platelets. In terms of adverse reactions, aspirin has the largest adverse reaction, followed by clopidogrel, and indobufen has relatively small adverse reactions.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.