Dabigatran and aspirin can both prevent cerebral infarction, but their indications are different

Several friends have consulted Huazi, saying that dabigatran can be used to prevent thrombosis and cerebral infarction, and its effect is similar to aspirin. What is the difference between the two drugs? Can they replace each other? Huazi said that although the two drugs have similar effects, dabigatran and aspirin have different pharmacological mechanisms and different indications, so they cannot replace each other.

Dabigatran is an anticoagulant drug, mainly used for thrombosis prevention in patients with atrial fibrillation, while aspirin is an antiplatelet drug, mainly used for thrombosis prevention in patients with atherosclerosis.

1. Two causes of cerebral infarction Cerebral infarction is a serious cerebrovascular disease, also known as ischemic stroke (also known as "stroke"). There are two main causes of its occurrence. One is atherosclerosis of the cerebral arteries. When the hardened plaques rupture, it will induce platelet aggregation to form thrombus.

Another reason is that the heart has left atrial fibrillation (AF), which prevents it from pumping blood normally, causing blood turbulence and clotting, and eventually forming blood clots. This cause of blood clot formation is related to the excessive activity of coagulation factors in the human body.

2. Different causes of thrombosis require different preventive medications. Because of the risk of thrombosis caused by atherosclerosis, antiplatelet drugs represented by aspirin need to be used on the basis of active anti-atherosclerosis. Inhibiting the aggregation of platelets can prevent the formation of thrombus when plaques rupture. Other drugs similar to aspirin include clopidogrel, ticagrelor, etc.

Because atrial fibrillation increases the risk of thrombosis, we should find ways to eliminate atrial fibrillation. However, some patients cannot eliminate atrial fibrillation, so they need to use anticoagulant drugs for a long time for anticoagulant treatment. Dabigatran is a thrombin inhibitor and an anticoagulant. Other drugs of the same type include warfarin and rivaroxaban.

3. What should be noted when using dabigatran? Dabigatran and aspirin are not the same type of drugs, there is no comparability between them, and they cannot replace each other. Among anticoagulant drugs, there is no saying "which is best" between dabigatran, rivaroxaban, and warfarin. It depends on which drug is more suitable for the patient.

Dabigatran is mainly excreted through the kidneys, so patients with moderate renal insufficiency (creatinine clearance 30-50 ml/min) need to use it at a reduced dose. Patients with severe renal insufficiency (creatinine clearance less than 30 ml/min) are not recommended to use it.

The use of dabigatran has the risk of causing intracranial hemorrhage and gastrointestinal bleeding. Compared with the traditional anticoagulant warfarin, dabigatran has a lower adverse reaction to cerebral hemorrhage, further reducing the incidence of stroke. However, the probability of dabigatran causing gastrointestinal bleeding is slightly increased.

There is no significant difference between dabigatran and rivaroxaban in the prevention of cerebral infarction, but the adverse reaction of intracranial hemorrhage caused by dabigatran is slightly lower. However, only a small part of rivaroxaban is metabolized by the kidneys, and most of it is metabolized by the liver, so the requirement for renal function is lower. Patients with creatinine clearance of 15-30ml/min can still use rivaroxaban.

If there is both atherosclerosis and atrial fibrillation, aspirin and dabigatran can be used together. However, the combination of the two will increase the risk of bleeding, and it needs to be evaluated by a doctor to make sure that the benefits of the combination outweigh the risks before it can be used with caution.

Dabigatran has a significant adverse reaction of gastrointestinal irritation and needs to be taken with or after meals to reduce gastrointestinal irritation. Proton pump inhibitors (prazole drugs) can be used under the guidance of a doctor to prevent gastrointestinal bleeding.

To sum up, although both dabigatran and aspirin can prevent thrombosis, the pharmacological mechanisms of the two drugs are different. Dabigatran is an anticoagulant drug used to prevent thrombosis caused by atrial fibrillation. Aspirin is an antiplatelet drug used to prevent thrombosis caused by atherosclerosis. The two drugs cannot replace each other, but they can be used together with caution. The drugs need to be used under the guidance of a doctor. If you have any questions about the use of the drugs, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.