Abstract
At a time when the rate of myocardial infarction recording shows shocking percentages and the question of whether there are other therapy measures adoptable to reduce heart attack cases, the research was inevitable. The research aimed to answer the question posed by the confusion that was generated as to whether myocardial infarction can be treated by clopidogrel and Plavix, as opposed to monotheraphy and aspirin.
The sources used in formulating clinical question were mainly from the National Institute of Health, Cochrane Library, MEDLINE and relevant books. The literature review in this research has clearly shown that the treatment of myocardial infarction is not limited to clopidogrel. Thus, discord of dual or monotherapy with aspirin and clopidogrel has proven reliable. In conclusion, the clinical trials and the reviewed data have shown that the rise in the rates of myocardial infarction is alarming. The curbing and treating of the disease will take proper coordination between the patient and the physician since lifestyle modifications can only be initiated by the patient.
Introduction
There are numerous diagnostic tests conducted to detect the heart muscle damage in an effective manner. Some are blood tests and use of electrocardiogram or echocardiography. The most used blood markers for the blood tests are creatine kinase fraction. Many cases of myocardial infraction are sometimes treated by the use of reperfusion therapy. Immediate diagnosis of myocardial infraction can be through the use of oxygen, aspirin and subliminal nitroglycerine (Hutchison, 2009). This paper focuses on presenting a review of the literature evidence regarding the treatment of myocardial infarction and the use of Clopidogrel and Plavix.
Evidence search
In this research, the patient intervention research method was adopted (PICO) to formulate a clinical question. In addition, the OVID, MEDLINE, PUBMED, AMERICAN HEART ASSOCIATION MIOCARDIAL INFARCTION GUIDELINES, a service available at the National Institute of health and Cochrane Library which encompasses data being arranged in databases that contain high quality data with credibility and neutral evidence to enhance informed decision on treatment of myocardial infarction.
In the literature search, the following key words were used and understood for literature search. The key terms include myocardial infarction; discord of dual or monotherapy, clopidogrel and Plavix. In the literature search, each question was identified in the clinical context and subsequently combined with the relevant articles. The research was further subjected to certain limitation, which includes use of English language and randomized review articles and books.
Literature Review
Geeganage (2010) argues that, in prevention of recurrent vascular events, it is important to consider dual antiplatelet since it usually gives out superior results compared to monotherapy treatment. In addition, the triple antiplatelet can also be used to achieve a comparing mode. In the research, random controlled research was put under investigation. The main aim of the investigation was to find out the effect of dual platelets compared to triple platelets on patients suffering from Myocardial infarction (MI) or acute myocardial infarction (AMI). A total of twenty randomized trials were completed.
Estimates of 17,383 patients were included in the investigation. Extraction of data was done from patients of myocardial infarction and stroke. Further, data on death and bleeding were analyzed with 95% random calculated effects models. The results of the said investigation found out that Triple therapy with intravenous inhibitor sufficiently had a reducing effect on the patients suffering from myocardial infraction.
The results showed 95% reduction in myocardial infarction and the same percentage with non ST elevation of acute coronary syndromes. It was further identified that there was a 95% reduction on the death of the patients admitted with myocardial infarction and treated with GP inhibitor. On the other hand, minor bleeding was also noted. Stroke events were significantly cut and no substantial data identified.
The identifiable results linked with the above mentioned investigation led to the following deductions. First, it was found out that the triple antiplatelet therapy based on GP inhibitor was more effective compared to aspirin dual therapy. Secondly, the results deduced that there was a reduction in the bleeding was detected. It was also evidenced that patients with elective PCI had no substantial effect when given triple therapy. There was 80% increase in transfusions and a noted increase in thrombocytopenia.
It is to be noted that what the foregoing research does is that it demonstrates that pathogens have an influence to different vascular syndromes. These vascular syndromes include myocardial infarction. Anti-platelet helps in bringing the said occurrence under prevention. The process of inhibiting platelets is one which requires blockade of the ADP platelet receptor. The blockade goes hand in hand with a significant increase in nitric oxide levels. From the conducted research, it has shown that many of the antiplatelet agents are taken orally, but the trend has changed due to indicators pointing at increased deaths.
Recurrent events are substantially reduced by use of aspirin. An estimation of 15-20% data from the use of indirect comparisons show that aspirin and clopidogel have different mechanisms, and there are indications that the drugs are addictive. The use of aspirin and clopidogrel is discouraged if it is used for long term prophylaxis. The use of the combined drugs for more than 6 months shows excess bleeding.
The most common drug linked with the treatment of cardial infarction is clopidogrel. In its nature, the drug requires inactive prodrug that relies on oxidation. The risk of heart attack can be substantially addressed by the little amount of aspirin dose. Studies have shown that aspirin is one of the widely used anti platelet agent. In the growing concerns of the efficacy of cardial infarction drugs, Plavix has been under scrutiny.
It is undisputable that Plavix rates are second to aspirin in selling. Clinical trials indicate that the combination of clopidogrel and aspirin is more effective mainly to patients with unstable angina and who have myocardial infarction. The combination does not increase the risk of bleeding in the short term. However, long term tests have proved that bleeding can occur in advanced stages of the use of the combination. The benefits are to be put at a weighing balance whereby the decision should be based on what out weighs the other between risk and benefits. It is also said that not all patients using the combination are affected. It has also been found out that prasugrel, which is an antiplatelet agent, is stronger than clopidogrel combined with aspirin (Topol, 2007).
Whereas the combination of aspirin and prasugrel is said to be effective, there is evidence that indicate that higher risks of major bleeding are possible compared to the aspirin and clopidogrel combination. The class of patients unlikely to benefit from the latter combination is those with history of stroke and low body weight and of the age of 75 and above years. The debate as to whether the benefits of aspirin combination with clopidogrel outweigh has more benefits than effects its still ongoing (Cannon, Steinberg & Sharis, 2011).
The combination of clopidogrel and aspirin is said to reduce death at a rate of 9% while reinfarction or stroke is reduced at a rate of 9.2%. The results are achieved despite the use of other treatments. It has argued that all patients with the history of myocardial infarction require a long term and well managed anti-platelet therapy. This is regardless of the nature of intervention used to treat it. Increased treatment has shown that many patients can survive. The key role of anti-platelets therapy cannot be ignored either before or after Myocardial infarction. Dual anti-platelet therapy with aspirin, which is otherwise known as a thromboxane inhibitor, is successful if carried out through clopidogrel or prasugrel. The recommended daily dose of aspirin ranges from 75mg to 325 mg (Khan, 2007).
Research conducted shows that premature stopping of antiplatelet therapy has disastrous effects on patients suffering from myocardial infarction shown that mortality can be reduced compared to historical controls. In recent years, it has been shown that ACE inhibitors play a role in reducing the mortality of myocardial infarction (Aschenbrenner & Venable, 2009).
Evidence has identified that high risk patients who continuously use aspirin have a reduced range of a vascular event. Also, in these patients, non-fatal strokes and death from vascular diseases are reduced. The rate of reduction ranges from 26%-32% compared with other types of treatments. In addition, segment elevation of myocardial infarction decrease when aspirin is used. It should be noted that there are post effects of aspirin range up to 72% increase in the amount of mortality. The non-adherence to blockers is said to constitute 10% to 40% increase in the cases of cardiovascular hospitalization (Grech, 2010).
Substantial question as to whether early identification and treatment of myocardial infraction can reduce the death rate from 50-60% has been raised. The answer to such a question has been hard to identify. However, it is clear that any effort is geared towards reducing the mortality and morbidity of myocardial infraction. There are studies that show that resuscitation saves lives. It has been found out that 75% of the sudden cardiovascular collapses are caused by fibrillation (Jacobson & Linden, 2011).
There are risk factors associated with myocardial deaths are said to have delineated in the recent past. Elevations of other substances, which increase blood pressure such as cigarette smoking, have led to increase in the risk. The most prominent prognostic variables are highly linked with the myocardial damage which is said to occur after the infarction. The natural history of the disease is highly determined by age (Iskandrian & Garcia, 2008).
Summary and Conclusion
Evidence from these studies clearly shows that the level of myocardial infarction is hitting the skies. The studies further indicate that several treatments have been used to help in reducing the risk of cardiovascular attack. The use of clopidogrel and Plavix has been considered one of the most famous forms of treatment. In addition, combination of aspirin and clopidogrel has also been taken into consideration. The greatest limiting factor in this research is that much time is required if highly reliable results are to unfold. The follow ups in the research require a lengthy time.
Clinical Recommendation
According to the literature reviewed, it has been established that the treatment of myocardial infarction is a process with numerous essential steps which must be followed in order to achieve reliable results. The combination of aspirin and clopidogrel is not in itself conclusive. Therefore, the thrombolytic therapy is necessary when dealing with acute myocardial infarction. On the other hand, a healthy lifestyle has to be in tandem with the treatment preferred. The intake of alcohol and cigarettes should be reduced and eventually abstained. The treatment of myocardial infarction requires patience and consistency.
The table of the studies
References
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