Chimes and cardiomagnyl. What is better chimes or cardiomagnyl
Antiplatelet therapy is an important component of primary and especially secondary prevention of cardiovascular diseases and their complications. Antiplatelet agents are usually prescribed, for example, in acute coronary syndrome (ACS), since ACS is based on a violation of the integrity of the atherosclerotic plaque, and patients suffering from this disease always experience thrombocytosis of varying severity. It is obvious that without the use of antiplatelet drugs, effective treatment of such patients is impossible. What about patients who do not have clinical manifestations of coronary heart disease? Should such patients be prescribed antiplatelet agents as a means of primary prevention of coronary artery disease?
On the other hand, there is now more and more reason to believe that the trigger for the inflammatory reaction in an atherosclerotic plaque may be hemorrhage into it. Therefore, the more aggressive we become in reducing blood clotting, the greater the likelihood of developing such a hemorrhage, and the reverse reaction is an increase in the incidence of thrombotic complications.
Also, when an atherosclerotic plaque does begin to lead to thrombosis, for quite a long time platelets are the only participants in the first line of defense; they cover the ruptured plaque and prevent the further development of thrombosis.
Previously, platelets were treated quite simply: they dropped some kind of inducer - the platelets stuck together; They gave me an aspirin tablet - the platelets did not stick together. But today it is already clear that these same blood platelets are an unusually complex structure. And this complex structure is involved not only in the processes of coagulation, but also in the processes of inflammation; there are many still unknown aspects of the action of these blood platelets.
But still, according to the results of international multicenter controlled studies, the most effective drugs for secondary prevention of ischemic cerebrovascular accidents are: acetylsalicylic acid, dipyridamole, ticlopidine and clopidogrel.
Aspirin irreversibly inhibits cyclooxygenase in platelets and endothelial cells, suppressing the formation of thromboxane A2, and in the case of high doses, prostacyclin. Within 1 hour after a single oral dose, aspirin reduces the ability of platelets to aggregate. Since mature platelets do not produce cyclooxygenase, the antiaggregation effect persists throughout their entire existence, i.e., at least 5 days.
Although the antiplatelet effect of aspirin (acetylsalicylic acid) develops quickly and differs in duration; it blocks only one (associated with the formation of cyclooxygenase) mechanism of platelet aggregation.
The drug Cardiomagnyl is a combination of acetylsalicylic acid and magnesium hydroxide for primary and secondary prevention of thrombosis.
Cardiomagnyl is a medical drug that is used to prevent blood clots. This drug helps reduce the risk of developing myocardial infarction in those patients who suffer from chronic coronary heart disease or who have a high risk of developing complications of the cardiovascular system, for example, they suffer from hypercholesterolemia, arterial hypertension, obesity, diabetes mellitus, as well as a family history, etc. problems.
Cardiomagnyl can be used to prevent recurrent blood clots in those patients who have suffered a stroke, transient ischemic attack, or myocardial infarction. The drug is used in therapy or during the development of acute myocardial infarction.
Cardiomagnyl contains the most optimal amount of acetylsalicylic acid, which meets all recommendations of the American and European Heart Associations, as well as the American Heart Association. Cardiomagnyl is the first combination of an antacid and acetylsalicylic acid, which protects the gastric mucosa from the irritating effects of acetylsalicylic acid.
The main indications for taking the drug Cardiomagnyl are:
- Our body is very wise and we know practically nothing about it!
- Is it necessary to use antiplatelet drugs as often as they are now prescribed?
Primary and secondary prevention of cardiovascular diseases accompanied by increased platelet aggregation such as thrombosis and acute heart failure in the presence of risk factors (for example, diabetes mellitus, hyperlipidemia, arterial hypertension, obesity, smoking, old age)
prevention of ischemic cerebrovascular accidents (including ischemic stroke)
Prevention of recurrent myocardial infarction and blood vessel thrombosis
unstable angina
in the postoperative period after surgical interventions on the heart and blood vessels (including after coronary artery bypass grafting and percutaneous transluminal coronary angioplasty).
You should be aware that there may be a 25-50% decrease in platelet levels in women during menstruation.
Platelets usually live only 8-10 days and are able to reproduce on their own, despite the absence of a cell nucleus. Until recently, it was generally accepted in the scientific community that platelets, formed from fragments of the cytoplasm of giant bone marrow cells (megakaryocytes), are not able to reproduce independently, since they do not have a cell nucleus. A healthy person has approximately 1.5 trillion platelets in their blood. But they are so small that the entire mass of platelets can be placed in two dessert spoons.
One of the main commandments of Hippocrates is “Eliminate the cause - the disease will go away!” forgotten by modern medicine.
Zenslim Cardio, a product of the wisdom of Ayurveda and 21st century technology, addresses and corrects the root causes of cardiovascular disease - not just the symptoms!
Can you take Cardiomagnyl with Cardioaspirin at the same time?
Is it possible to take cardiomagnyl with cardioaspirin at the same time?
For what? they are practically the same. Cardiomagnyl is a combination of acetylsalicylic acid and magnesium hydroxide, and cardioaspirin contains only acetylsalicylic acid.
Why are oral anticoagulants needed?
Why are oral anticoagulants needed?
Anticoagulants are medications that reduce the activity of the blood coagulation system and prevent excessive blood clot formation. Modern anticoagulants affect various parts of the blood coagulation process and are used for the prevention and treatment of arterial or venous thrombosis and thromboembolism.
Classification of anticoagulants
All anticoagulant drugs are divided into two large groups:
- direct anticoagulants (drugs prescribed by injection) that inhibit thrombin activity - direct anticoagulants;
- indirect anticoagulants, or oral anticoagulants (prescribed in tablet form as rivaroxaban), which interfere with the formation of prothrombin in the liver. They are also called vitamin K antagonists, or indirect anticoagulants.
- Rivaroxaban is characterized by a rapid onset of action, high bioavailability and a stable, predictable dose-dependent anticoagulant effect, does not require monitoring of coagulation parameters and dietary restrictions, and exhibits minimal interaction with drugs.
Can menstruation come earlier from cardiomagnyl?
Can menstruation come earlier from cardiomagnyl?
We think not, but prolonged and heavy bleeding during menstruation may be from taking Cardiomagnyl, since Cardiomagnyl suppresses platelet aggregation and thereby reduces blood clotting ability. Therefore, before prescribing this drug, it is very important to be sure that the person does not have a decrease in these indicators and does not have a tendency to bleed. The reasons for increased bleeding may be different, but in any case, such people should not take cardiomagnyl.
If such patients are prescribed cardiomagnyl, their tendency to bleeding will increase, including internal bleeding, for example, with the development of an ulcerative process in the gastrointestinal tract.
Can cardiomagnet be taken without a doctor's prescription?
Can cardiomagnet be taken without a doctor's prescription?
Self-prescription of ANY drug is unacceptable!
Firstly - cardiomagnyl. Secondly - for what purpose? How old are you and do you have any health problems?
Cardiomagnyl is aspirin, some people are intolerant! Better, on the doctor's recommendation!
Tranexam is extremely undesirable in the presence of blood clots. The combination with cardiomagnyl is a bad solution, but possible if necessary. It is somewhat worse that tranexam is combined with heparin, which is administered to you during hemodialysis. Perhaps some of the heaviness of your periods is associated with treatment with heparin, which is necessary during hemodialysis. Then it is more optimal to discuss with your hemodialysis doctor the possibility of reducing the dose of heparin or replacing it with Clexane/Fraxiparine. Perhaps in this case there will be no need to prescribe tranexam. Discuss your treatment with a gynecologist, hemodialysis doctor and a doctor who treats thrombosis, and inform the doctors of the arguments presented here.
Aspirin does not always help the heart
Aspirin does not always help the heart
Scientists at Baylor College of Medicine have come to the conclusion that aspirin not only provides benefits to the body, but also harms it. This conclusion was made as a result of studies involving 68 thousand patients who suffer from cardiovascular diseases. They took aspirin expecting a positive effect. Studies have shown that in some cases the risk of side effects significantly exceeded the potential benefit to humans. About 10% of people who take aspirin put their body at risk. But the remaining 90% can actually alleviate their suffering with its help. For this reason, doctors advise not to take aspirin unless directed by a doctor.
Is it possible to take cardiomagnyl and tranexan?
Is it possible to take cardiomagnyl and tranexan?
I am undergoing hemodialysis. Blood clots have formed, I was prescribed Cardiomagnyl 150 mg. The gynecologist prescribed tranexan during my period. Is it possible to take these two medications at the same time?
Tranexam is extremely undesirable in the presence of blood clots. The combination with cardiomagnyl is a bad solution, but possible if necessary. It is somewhat worse that tranexam is combined with heparin, which is administered to you during hemodialysis. Perhaps some of the heaviness of your periods is associated with treatment with heparin, which is necessary during hemodialysis. Then it is more optimal to discuss with your hemodialysis doctor the possibility of reducing the dose of heparin or replacing it with Clexane/Fraxiparine. Perhaps in this case there will be no need to prescribe tranexam. Discuss your treatment with a gynecologist, hemodialysis doctor and a doctor who treats thrombosis, and inform the doctors of the arguments presented here.
Is it possible to take Cardiomagnyl constantly or do you need to redo it?
Is it possible to take Cardiomagnyl continuously or do you need to take breaks?
It’s better to ask your doctor, since cardiology is too complex a topic and no one will tell you anything sensible in absentia.
donate blood for clotting, if everything is normal, you can take a break. but get tested periodically.
Is it possible to take Cardiomagnyl after a hemorrhagic stroke?
Is it possible to take Cardiomagnyl after a hemorrhagic stroke?
Cardiomagnyl is a drug that prevents the development of ischemic stroke, which can occur due to a sharp narrowing or thrombosis of cerebral vessels. But in case of hemorrhagic stroke, cardiomagnyl is contraindicated, since this type of stroke develops when a blood vessel ruptures and blood enters the brain tissue. If blood clotting is reduced, the hemorrhage will be more extensive, so in this case, patients are prescribed hemostatic agents.
cardioaspirin or cardiomagnyl?
After a heart attack and stenting, I was prescribed Plavix and cardioaspirin. Due to problems with the gastric mucosa, I replaced the latter with cardiomagnyl. Did I do the right thing?
Cardiomagnyl is a combination of acetylsalicylic acid and magnesium hydroxide, and cardioaspirin contains only acetylsalicylic acid. the choice is yours
What irritates the stomach walls less?
probably the same since the amount of acetylsalicylic acid is almost the same
Should I take it at night or after dinner?
better before dinner
What is better to take chimes or cardiomagnyl after an injury?
What is better to take chimes or cardiomagnyl after a stroke?
they have different mechanisms of action.
Composition of Curantyl Dipyridamole. Curantil affects both primary and secondary platelet aggregation. Inhibits their adhesion, potentiates the antiaggregation effect of prostacyclin. In the mechanism of action, inhibition of phosphodiesterase and an increase in the content of cAMP in platelets is essential, which leads to inhibition of their aggregation. In addition, the release of prostacyclin by endothelial cells is stimulated, and the formation of thromboxane A 2 is inhibited. It has a vasodilating effect on coronary vessels by inhibiting adenosine deaminase (this property is used for pharmacological tests), inhibits the reuptake of adenosine by erythrocytes (possibly by influencing a special nucleoside transporter in the cell membrane) and increases its concentration in the blood. Adenosine stimulates adenylate cyclase and, in turn, increases the cAMP content in platelets. Along with this, it affects the smooth muscles of blood vessels and prevents the release of catecholamines.
As an antiaggregation agent, it is often used in combination with acetylsalicylic acid, i.e. with cardiomagnyl.
Should I take Cardiomagnyl once a day or twice?
Should I take Cardiomagnyl once a day or twice?
For the primary prevention of cardiovascular diseases, such as thrombosis and acute heart failure in the presence of risk factors (for example, diabetes mellitus, hyperlipidemia, arterial hypertension, obesity, smoking, old age), 1 tablet is prescribed. Cardiomagnyl containing acetylsalicylic acid in a dose of 150 mg on the first day, then 1 tablet. Cardiomagnyl containing acetylsalicylic acid in a dose of 75 mg 1 time / day.
To prevent recurrent myocardial infarction and thrombosis of blood vessels, 1 tablet is prescribed. Cardiomagnyl containing acetylsalicylic acid in a dose of 75-150 mg 1 time / day.
To prevent thromboembolism after vascular surgery (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty), 1 tablet is prescribed. Cardiomagnyl containing acetylsalicylic acid in a dose of 75-150 mg 1 time / day.
For unstable angina, 1 tablet is prescribed. Cardiomagnyl containing acetylsalicylic acid in a dose of 75-150 mg 1 time / day.
What should I take instead of aspirin to thin my blood?
What should I take instead of aspirin to thin my blood?
There are a lot of anticoagulants. but they are prescribed only by a doctor. some take ThromboASS, AspirinCardio, Cardiomagnyl, Trental
New function of platelets discovered
New function of platelets discovered
Lymphocytes, or white blood cells, are cells of the immune system that, circulating in the bloodstream and migrating to the lymph nodes, carry out so-called immune surveillance: they “look for” harmful substances and microorganisms. For a long time, it remained unknown why bleeding does not occur when white blood cells pass from small vessels - venules - to lymph nodes.
As study authors Lijun Xia and Brett Herzog found, platelets, which produce signaling molecules during the migration of white blood cells, help prevent bleeding. These molecules, in turn, cause an increase in the level of a substance in the venules that ensures the connection of cells in the walls of the vessel.
- We have discovered a new function of platelets, in which they produce signaling molecules, but do not contact each other - this avoids thrombus formation,- Xia explained. According to the authors of the work, this discovery could lead to new methods of treating bleeding.
Is it possible to start drinking cardiomagnyl at 25 years old if you already have
Is it possible to start drinking cardiomagnyl at the age of 25 if you already have problems with the heart and blood vessels?!
It depends on the problems. In general, one recipe, which will soon be 100 years old, will not harm all hearts.
200 grams of black raisins
200 grams of walnut kernels
200 grams of dried apricots
2 lemons with peel
grind into a meat grinder
add 200 grams of honey (natural)
mix, store in the refrigerator, take a tablespoon in the morning half an hour before meals. Repeat the course 2 times a year.
This is a complete cocktail, rich in potassium-magnesium compounds, which are simply necessary for normal heart function. If you struggle with constipation, then add 200 grams of prunes.
And cardiomagnyl is a chemical, what will be more of it - benefit or harm - is another question...
Only as prescribed by the attending physician. Cardiomagnyl is not as harmless as you think. Cardiomagnyl is aspirin + magnesium and this drug has a lot of contraindications...
It is mainly indicated for acute and chronic coronary heart disease and as a prevention of thrombosis.
What can replace cardiomagnyl?
What can replace cardiomagnyl?
Cardiomagnyl belongs to the group of non-hormonal, non-narcotic anti-inflammatory drugs. It is used as a preventive and therapeutic agent for various diseases of the heart and blood vessels. According to some data, the use of small dosages of this drug makes it possible to reduce the likelihood of developing severe heart and vascular diseases by 25%.
Main active ingredients: acetylsalicylic acid and magnesium hydroxide.
The drug prevents platelet aggregation (sticking together) by reducing the production of the substance thromboxane. Acetylsalicylic acid affects the mechanism of platelet adhesion in several directions, so this drug is often used today for diseases of the blood vessels and heart. In addition, this component reduces pain, relieves inflammation and reduces body temperature.
The second component of cardiomagnyl, magnesium hydroxide, is an antacid and helps prevent the destruction of the wall of the digestive tract by acetylsalicylic acid. Magnesium hydroxide interacts with gastric juice and hydrochloric acid, and also covers the walls of the stomach with a protective film. The action of both components occurs in parallel; they do not affect each other’s effectiveness.
Analogues: Thrombo-ass, Aspirin-cardio.
The drug can be replaced; this is a common procedure for aspirin intolerance. The cardiologist can advise you on a replacement medication.
How are antiplatelet agents different from anticoagulants?
How are antiplatelet agents different from anticoagulants?
ANTICOAGULANTS (anticoagulantia; Greek anti- against + Latin coagulans, coagulantis causing clotting) are medications that inhibit the blood clotting process and thereby prevent the formation of blood clots.
Antiplatelet agents (Greek anti- against + Latin aggregans, aggregantis adding) drugs that inhibit platelet aggregation.
For example, Aspirin prevents platelet sticking (aggregation). Anticoagulants act on non-cellular blood clotting factors.
Anticoagulants mainly inhibit the formation of fibrin filaments; they prevent thrombus formation, help stop the growth of existing blood clots, and enhance the effect of endogenous fibrinolytic enzymes on blood clots.
Anticoagulants are divided into 2 groups: a) direct anticoagulants - fast-acting (sodium heparin, calcium nadroparin, sodium enoxaparin, etc.), effective in vitro And in vivo; b) indirect anticoagulants (vitamin K antagonists) - long-acting (warfarin, phenindione, acenocoumarol, etc.), act only in vivo and after the latent period.
The anticoagulation effect of heparin is associated with a direct effect on the blood coagulation system due to the formation of complexes with many hemocoagulation factors and is manifested in the inhibition of coagulation phases I, II and III. Heparin itself is activated only in the presence of antithrombin III.
Indirect anticoagulants - derivatives of oxycoumarin, indanedione, competitively inhibit vitamin K reductase, thereby inhibiting the activation of the latter in the body and stopping the synthesis of vitamin K-dependent plasma hemostasis factors - II, VII, IX, X.
What side effects can occur when taking Cardiomagnyl?
What side effects can occur when taking Cardiomagnyl?
When treated with cardiomagnyl, patients may experience discomfort in the stomach caused by the irritant effect of the drug on the mucous membrane. Therefore, all patients with gastric and duodenal ulcers must inform the doctor who prescribes cardiomagnyl about this.
cardiomagnyl - what is it?
cardiomagnyl - what is it?
Cardiomagnyl- a drug that is used for primary and secondary prevention of thrombosis. Cardiomagnyl – This tablets containing acetylsalicylic acid, magnesium hydroxide and various excipients in packages of 30 or 100 pieces.
To prevent thrombosis, acetylsalicylic acid is used in a dosage ten times less than the dose prescribed for pain relief. Therefore, cardiomagnyl exhibits side effects and contraindications in this case to a much lesser extent.
Cardiomagnyl during pregnancy
Cardiomagnyl during pregnancy
Pregnancy is a time when a “restructuring” occurs in the functioning of all body systems, a woman’s immunity is significantly reduced and she becomes more “open” to infections, an exacerbation of chronic diseases is possible, as well as the development of pathological processes. So, willy-nilly, you have to take medications prescribed by your doctor. And here comes the time for the question to arise: how justified and safe is it for the expectant mother and her child to take this or that medicine? After all, it would seem that even the most “harmless” medications can still cause side effects. What should you do if a pregnant woman suffering from varicose veins is prescribed such a rather serious drug as Cardiomagnyl? Should you listen to the doctor in this case? Let's try to answer this question.
Is Cardiomagnyl necessary during pregnancy?
Cardiomagnyl is prescribed for the prevention of thrombosis, heart attacks, strokes, and cerebrovascular accidents. This combination drug contains acetylsalicylic acid (or, more simply, aspirin) and magnesium hydroxide, which reduces the possible side effects of aspirin. This is where the reason for worry for the expectant mother lies, because everyone knows that it is better to refuse to take acetylsalicylic acid during pregnancy, since it can negatively affect two organisms at once - the pregnant woman and her unborn child.
Why is Cardiomagnyl so dangerous during pregnancy?
Even the instructions for the drug itself state that its use by pregnant and breastfeeding women is contraindicated. This is due to the possible occurrence of such serious side effects as bleeding in the expectant mother, delayed labor, as well as the occurrence of developmental defects and cerebral hemorrhages in the fetus. In addition, acetylsalicylic acid has the ability to penetrate the placenta and can provoke the development of congenital anomalies such as cleft palate, cleft lip, underdeveloped limbs, etc.
What to do when taking Cardiomagnyl is prescribed by your doctor?
Prescribing Cardiomagnyl during pregnancy by your attending physician is a serious and justified decision. Many expectant mothers are “overtaken” by a disease such as varicose veins, in which taking “Cardiomagnyl” will help avoid the formation of blood clots (which is deadly for a woman), and also, by “making” the blood more liquid, will facilitate its movement through the vessels.
When can you take Cardiomagnyl during pregnancy?
Taking this drug is permissible only in the second trimester, when the expected benefit from it exceeds the occurrence of possible side effects. During this period, the placenta begins to function, which is already able to prevent many medications from passing through itself. In addition, most often the basic organs and vital systems of the child have already been formed.
There is also a “moratorium” on taking the drug in the third trimester of pregnancy, since acetylsalicylic acid (aspirin) can provoke bleeding not only in the expectant mother, but also in the fetus, as well as a delay in labor. It can also affect the state of the child’s cardiovascular system (possible premature closure of the ductus arteriosus).
You should not take Cardiomagnyl during lactation, since aspirin passes into breast milk. If you need a one-time dose of the drug, then complications should not arise, but in no case should it be taken systemically. Otherwise, you will have to make a difficult choice: either take Cardiomagnyl or refuse to breastfeed your child.
"Cardiomagnyl" during pregnancy: for or against?
Taking Cardiomagnyl is prescribed for preventive purposes in case of a tendency to blood clots. If this disease is detected in a pregnant woman, it is best to prescribe her other medications that cannot adversely affect the fetus. Therefore, even in the permitted second trimester of pregnancy, there is no urgent need to prescribe Cardiomagnyl. If, nevertheless, the drug is prescribed to you, the main thing, despite all the possible side effects, is not to self-medicate, but to take it only as prescribed by the attending physician, being under his supervision and strictly adhering to the prescribed dosage.
Treatment with cardiomagnyl - preventive, as prescribed by a doctor
Treatment with cardiomagnyl - preventive, as prescribed by a doctor
Ardiomagnyl is a drug that is used to prevent complications of diseases accompanied by an increased ability of platelets to stick together (aggregate). Cardiomagnyl is not used to treat diseases.
Cardiomagnyl is a drug for the prevention of thrombosis
The main active ingredient in cardiomagnyl is acetylsalicylic acid (aspirin). This drug belongs to non-steroidal anti-inflammatory drugs (NSAIDs); it was previously used as an antipyretic, anti-inflammatory and analgesic agent. But today NSAIDs are produced that are significantly superior to aspirin in all these properties and have much fewer side effects.
In recent years, aspirin is increasingly prescribed for prophylactic purposes, using another of its properties - the ability to prevent platelet aggregation, since platelets, when sticking together, become the basis for the formation of blood clots. Blood clots clog blood vessels and organ tissues deprived of nutrition die. This mechanism underlies myocardial infarction, ischemic stroke and other diseases.
Therefore, cardiomagnyl is prescribed for certain diseases that are often complicated by thrombosis. This is the prevention of serious complications. Since cardiomagnyl is prescribed, albeit in small doses, but in long courses, great importance is attached to its possible side effects. The most dangerous side effect of this drug is its irritating effect on the gastric mucosa. With long-term courses of taking cardiomagnyl, this can lead to the formation of erosions, ulcers in the stomach and even gastric bleeding.
To avoid irritating effects on the walls of the stomach, cardiomagnyl contains magnesium hydroxide.
Preventive courses of cardiomagnyl for various cardiovascular diseases
In diseases of the heart and blood vessels, blood stagnation often occurs in certain areas of the circulatory system. Such diseases include, first of all, coronary heart disease, which develops against the background of the deposition of atherosclerotic plaques on the walls of blood vessels supplying blood to the heart muscle (coronary vessels). As a result, even with a slight spasm of such altered vessels, their patency is impaired, which manifests itself in the form of angina attacks - severe sudden pain in the heart, radiating to the left arm. Such pain must be immediately relieved with nitroglycerin, which dilates the coronary vessels; if this is not done, myocardial infarction will occur - the death of heart muscle tissue. Myocardial infarction can also begin if the lumen of the coronary artery is blocked by a blood clot.
The same mechanism of the disease occurs in cases of cerebral circulation disorders - this leads to ischemic stroke. Migraines are also dangerous - a sharp sudden expansion of the blood vessels of the brain with stagnation of blood in them, which is manifested by severe headaches, sometimes in one half of the head. Therefore, to prevent the development of myocardial infarction and ischemic stroke, long-term preventive courses of cardiomagnyl are prescribed.
You will also need to take cardiomagnyl when performing surgical operations on blood vessels - this prevents the formation of blood clots, their separation and “travel” through the circulatory system with subsequent possible blockage of large vessels - this disease is called thromboembolism.
How to use
Acetylsalicylic acid, which is part of cardiomagnyl, has many contraindications and side effects, so a doctor should prescribe courses of cardiomagnyl.
Cardiomagnyl tablets are best taken whole with water. But it’s quite possible to chew them. This distinguishes cardiomagnyl from other drugs containing aspirin and enteric-coated to prevent stomach irritation. In Cardiomagnyl, the stomach is protected by magnesium hydroxide, which is located inside the tablet.
To prevent cardiovascular diseases with risk factors such as high blood pressure, diabetes, obesity, as well as for smokers and older people, cardiomagnyl is prescribed two tablets on the first day, and then one tablet per day. To prevent recurrent myocardial infarction, cardiomagnyl is taken one or two tablets once a day. To prevent thromboembolism after vascular surgery, cardiomagnyl is taken one tablet per day. The duration of the preventive course is determined by the doctor.
Cardiomagnyl is a high-quality drug for the prevention of complications of cardiovascular diseases.
I took cardiomagnyl to thin the blood, everything returned to normal
I took cardiomagnyl to thin the blood, everything returned to normal, but there was terrible swelling from it. They say cardiomagnyl is no better than aspirin
Triple antiplatelet therapy. Pros and cons of combining
Triple antiplatelet therapy. Pros and cons of combining antiplatelet and anticoagulant drugs
Long-term antiplatelet and anticoagulant therapy has long proven its advantages in the prevention of thrombotic and thromboembolic complications. Thousands of cardiovascular patients around the world take antiplatelet drugs or oral anticoagulants for months or even years, depending on which strategy is preferable in a particular clinical situation.
However, the doctor often has to solve a difficult problem - what to do if the patient is equally prescribed both antiplatelet drugs and an oral anticoagulant? Can warfarin be added to the treatment regimen if the patient is already taking aspirin, clopidogrel, or a combination of both? Will such comprehensive antithrombotic therapy provide additional protection or will it be unjustified, or even dangerous due to an increased risk of bleeding?
Persons with combined cardiovascular pathology are more common than with any single disease. In this case, the patient may have strict indications for both long-term use of anticoagulants and long-term, if not permanent, antiplatelet therapy (and often in the form of a combination of two different drugs). Sometimes such complex clinical situations are specified in current practice guidelines, but more often you have to make a decision yourself, weighing the benefits and risks of such a fairly aggressive antiplatelet combination for a given patient. The current evidence base in this regard is replete with contradictions and blind spots: many studies indicate a significant increase in the risk of bleeding complications with a slight increase in effectiveness or no benefit of this combination, but there is also more optimistic data.
Relevance of combined antiplatelet therapy (antiplatelet drug + anticoagulant)
The practice of combined use of antiplatelet and anticoagulant drugs is quite common, being in demand by a wide variety of categories of patients. Moreover, every year the need for such an aggressive antiplatelet strategy for the management of cardiac patients increases. According to S.G. Johnson et al. (2007), approximately 4 out of 10 American patients taking warfarin also receive antiplatelet drugs (in most cases, acetylsalicylic acid (ASA), clopidogrel, dipyridamole, or a combination of ASA with clopidogrel or dipyridamole). The combination of antiplatelet therapy and warfarin is especially common in patients with heart failure, coronary artery disease (CHD), as well as in those who have had a stroke or transient ischemic attack (TIA).
The largest meta-analysis by the Antithrombotic Trialists' Collaboration, which combined the results of 145 clinical trials, showed that the use of antiplatelet therapy in high-risk patients reduces the risk of cardiovascular events by 25%. Particularly significant benefits of antiplatelet therapy are observed in patients who have suffered acute coronary syndrome (ACS), as well as in those who have undergone coronary artery intervention, primarily with stent placement.
In addition, it has now been proven that for many categories of high-risk cardiovascular patients, long-term antiplatelet therapy is preferable in the form of a combination of two drugs with different mechanisms of action. To date, the most convincing evidence base is for the combination of ASA and clopidogrel - a number of large randomized studies have demonstrated that the use of such a combination is more effective than monotherapy with ASA, clopidogrel or any other antiplatelet agent, reduces the risk of ischemic events with comparable safety (CURE, CREDO , CHARISMA, CLARITY-TIMI 28, COMMIT/CCS-2). The benefits of dual antiplatelet therapy were especially pronounced in patients with ACS, as well as in patients after percutaneous coronary intervention (PCI) with the installation of coronary stents, therefore long-term use of a combination of ASA and clopidogrel is today a mandatory requirement for patients who have undergone ACS (both with elevation ST, and without it), especially in the case of PCI.
Along with this, many patients may also require short-term or rather long-term therapy with oral anticoagulants: this applies primarily to patients with atrial fibrillation, persons with valvular heart disease, mechanical prosthetic heart valves, mural thrombi of the left ventricle, as well as post-infarction patients with a high risk of developing intracardiac blood clot The use of warfarin in such patients reliably and significantly reduces the risk of cardioembolic stroke. In addition, anticoagulants are indicated in the case of deep vein thrombosis of the lower extremities and other manifestations of venous thromboembolism - while taking warfarin in such patients, the risk of pulmonary embolism (PE) is significantly reduced.
Thus, for many cardiovascular patients, for a more or less long term, there is a need to combine antiplatelet therapy with oral anticoagulants. The issue of such combination has become especially relevant after recent updates to practical guidelines on the treatment of ACS. According to these guidelines, significant benefits of long-term antiplatelet therapy after coronary stenting have been proven, and the recommended duration of taking a combination of antiplatelet drugs (ASA and clopidogrel) has increased to a year in most patients with installed coronary stents. If it is necessary to prescribe warfarin against the background of such dual antiplatelet therapy, many doubts and questions arise.
According to the latest update of the European Society of Cardiology guidelines (2008), in the case of a high risk of thromboembolic events, patients who have had an elevation myocardial infarction ST, may receive oral anticoagulants in combination with low-dose ASA (IIa, B), clopidogrel (IIb, C) or dual antiplatelet therapy (ASA + clopidogrel) (IIb, C). The combination of warfarin and ASA is indicated for high risk of thromboembolism; a combination of warfarin and dual antiplatelet therapy - after stenting, if there are indications for taking oral anticoagulants; a combination of warfarin and clopidogrel - after stenting, if there are indications for taking oral anticoagulants, and there is a high risk of bleeding. However, what are the main benefits and risks of such treatment?
The problem of hemorrhagic complications of antiplatelet therapy is one of the most serious iatrogenic problems of modern medicine. In recent years, there have been increasing reports that hemorrhages caused by taking antiplatelet agents are one of the most common side effects of drug therapy. Many of these hemorrhagic complications are very serious, leading to acute cerebrovascular accidents, dangerous gastrointestinal bleeding, and fatal outcomes. Therefore, it is natural that the increasing aggressiveness of antiplatelet therapy, especially in the situation of combining several different antithrombotic agents, becomes a stumbling block.
Nevertheless, there is reason to believe that after careful selection of patients for combination antiplatelet therapy, the use of combinations with maximum advantages in terms of the overall efficacy-safety indicator and subject to strict monitoring of hemostasis, the benefits of such treatment will be significantly higher than the possible risks.
Evidence base
ASA + warfarin
One of the first major works devoted to the study of the combination of ASA and warfarin was a meta-analysis by P. Loewen et al. (1998), who pooled data from 16 studies comparing this combination with warfarin monotherapy. This meta-analysis showed that long-term use of warfarin with chronic ASA therapy is fully justified in patients with mechanical prosthetic heart valves at high risk of thromboembolic complications. In addition, this strategy, according to P. Loewen et al., can also be used for the primary prevention of thromboembolism in individuals at high risk of developing coronary artery disease, although in this case the expected benefits are small. However, the authors could not confirm the advisability of using a combination of ASA and warfarin in patients suffering from coronary artery disease, atrial fibrillation, ischemic stroke or coronary artery bypass surgery - in these situations, the increasing risk of hemorrhagic complications could not be compensated by the advantages of such a combination in relation to the prevention of thromboembolism.
A number of subsequent studies have also demonstrated that combining long-term antiplatelet and anticoagulant therapy may significantly increase the risk of bleeding complications.
In a meta-analysis by R.J. Larson, E.S. Fisher (2004), which included 9 large studies that compared warfarin therapy with a combination of warfarin and ASA, showed clear advantages of combining two antiplatelet agents compared with warfarin monotherapy (additional reduction in the risk of thromboembolic events and overall mortality) in patients with mechanical prosthetic heart valves . For other categories of patients included in this meta-analysis (myocardial infarction or atrial fibrillation), such benefits could not be confirmed - the data obtained were contradictory, and differences between groups often could not reach statistically significant values.
According to the pharmacoeconomic analysis of S.G. Johnson et al. (2008), the risks associated with adding warfarin to antiplatelet drugs (ASA, clopidogrel and/or dipyridamole) outweighed the benefits. However, this study was retrospective, short-term (6 months), and examined the entire population of patients receiving the antiplatelet combination, regardless of underlying pathology and other factors that might influence the benefit/risk ratio.
In the randomized multicenter study WARIS II (M. Hurlen et al., 2002), which involved 3630 patients who had suffered a myocardial infarction, the combination of ASA with warfarin compared with ASA monotherapy resulted in a reduction in the incidence of major cardiovascular events (recurrent nonfatal infarction, thromboembolic stroke, death) – 15 vs 20% (p=0.001). However, in the combination treatment group, the risk of hemorrhagic complications also increased (0.62 vs 0.17% for serious non-fatal hemorrhages, p<0,001).
In the same 2002, two more studies were completed comparing different strategies of antiplatelet therapy in patients who had suffered ACS - ASPECT-2 (R.F. van Es et al., 2002) and APRICOT-2 (M.A. Brouwer et al., 2002). Both studies showed that the use of a combination of ASA and an oral anticoagulant after ACS significantly reduced the risk of major ischemic events and death compared with ASA monotherapy. At the same time, the risk of hemorrhagic complications increased slightly and mainly due to small, harmless hemorrhages. In the APRICOT-2 study, the benefits of the combination were expressed in reducing the risk of reocclusion (15 vs 28% for TIMI ≤2, p<0,02; 9 vs 20% for TIMI 0-1, p<0,02), потребности в реваскуляризации (31 vs 13%, p<0,01), повторного инфаркта (8 vs 2%, p<0,05) и повышении выживаемости больных (86 vs 66%, p<0,01) на протяжении 3 мес после ОКС. В ASPECT-2 комбинация АСК и варфарина у пациентов, перенесших ОКС, привела к снижению частоты регистрации комбинированной конечной точки (инфаркт, инсульт или смерть) по сравнению с монотерапией АСК (5 vs 9%, p=0.03), although there were no significant differences compared with warfarin monotherapy.
Interesting results of the meta-analysis by F. Dentali et al. (2007), who combined the results of ten randomized clinical trials comparing the combination of ASA and warfarin with warfarin monotherapy. According to the results, the risk of thromboembolic complications in patients taking the combination of drugs was lower than in the warfarin monotherapy group, but these benefits were limited to the subgroup of patients with mechanical prosthetic heart valves. For other categories of patients (with atrial fibrillation or coronary artery disease), no differences were noted in the risk of thromboembolic complications and mortality. Moreover, the risk of serious hemorrhagic complications in the combination therapy group was higher than when taking warfarin alone. The benefits of using a combination of ASA and warfarin over warfarin monotherapy in patients undergoing heart valve replacement were previously shown in another meta-analysis by J.C. Cappelleri et al. (1995). According to these authors, the combination reduced the risk of thromboembolic complications by 67% and overall mortality by 40%, although an increase in the risk of hemorrhagic events was also noted.
Taking into account the data from these and other studies and meta-analyses, it was concluded that the combination of ASA and warfarin is preferable in patients with mechanical prosthetic heart valves.
In a large meta-analysis by F. Andreotti et al. (2006), which included the results of a 5-year observation of more than 10 thousand patients who had suffered ACS, the combination of ASA and an oral anticoagulant (INR 2-3) helped prevent 3 serious cardiovascular events per 100 patients, but at the same time caused 1 serious hemorrhagic complication per 100 patients (compared to ASA monotherapy). In this regard, experts from the European Society of Cardiology concluded that the combination of ASA and an oral anticoagulant may be a reasonable strategy in people who have had a heart attack with elevation ST, in case of high risk of thromboembolic events.
ASA + clopidogrel + warfarin
Unfortunately, to date there is little evidence comparing the benefits and risks of triple antiplatelet therapy with other strategies (ASA monotherapy, clopidogrel or warfarin, dual antiplatelet therapy, a combination of one antiplatelet drug and warfarin, etc.). According to A.J. Hermosillo and S.A. Spinler (2008), who performed a systematic review of the available evidence on this issue (from 1966 to March 2008), only 12 such studies were published in the Medline database, and only one of them was randomized (and open-label). Four of these 12 studies showed benefits of triple antiplatelet therapy without a clinically significant increase in the risk of hemorrhagic complications, but the remaining 8 studies showed a 3- to 6-fold increase in the risk of hemorrhage. In 6 of these 12 studies, the effect of treatment on ischemic events was not analyzed at all (only safety was studied).
For example, in a large retrospective cohort study, Y. Konstantino et al. (2006) the use of triple antiplatelet therapy (ASA + thienopyridine + warfarin) in patients with high-risk ACS did not lead to an increase in mortality (neither by the 30th day after ACS, nor six months later) compared with double antiplatelet therapy (aspirin + thienopyridine), despite a 4-fold increase in the risk of hemorrhagic complications in the triple combination group. In addition, in the dual therapy group there was a trend towards an increase in the need of patients for revascularization in the first 30 days after ACS. Based on the study results, the authors concluded that triple antiplatelet therapy, when both an antiplatelet agent and an anticoagulant are indicated, may be justified in high-risk patients, given the lack of difference in mortality.
Similar conclusions were drawn from the results of a study by A. Porter et al. (2006) for patients undergoing PCI. Unfortunately, this study did not have a control group, but the available data made it possible to judge that the benefits of triple antiplatelet therapy in such patients are not accompanied by a significant increase in the risk of hemorrhagic complications.
In a study by M.C. Nguyen et al. (2007) the addition of warfarin to antiplatelet drugs (ASA, clopidogrel, or their combination) in patients with ACS who underwent PCI did not lead to a significant increase in hemorrhagic complications over a 6-month follow-up, and in patients with atrial fibrillation, triple antiplatelet therapy provided additional benefits in regarding stroke prevention. The same group of authors in a study based on post hoc analysis of data from the EXTRACT-TIMI 25 study, in the same year showed that triple antiplatelet therapy can be quite safe in patients who have had an elevation ACS ST, including after PCI.
Finally, in a recent study by J. Ruiz-Nodar et al. (2008) demonstrated that triple antiplatelet therapy is preferable in patients with atrial fibrillation who require PCI, provided that the risk of hemorrhagic complications is initially low. The results obtained indicate that the addition of warfarin to dual antiplatelet therapy (ASA + clopidogrel) in such patients significantly reduces both the incidence of the combined endpoint (death, heart attack, need for revascularization) and overall mortality, while the risk of serious hemorrhagic complications in such a triple combination did not increase significantly. This is the largest study to date examining the effect of triple antiplatelet therapy on both thromboembolic events and bleeding complications.
However, in most studies, the addition of warfarin to dual antiplatelet therapy (ASA + thienopyridine) was associated with a significant increase in the risk of bleeding complications - 3-6 times. The advantages of such an aggressive antiplatelet combination over dual antiplatelet therapy according to different studies are contradictory - they are either absent or not so significant that the increased risk of hemorrhage can be neglected.
Thus, in a population study by K. Buresly et al. (2005) analyzed data from more than 20 thousand elderly patients who had suffered a myocardial infarction. At the same time, the authors compared the risk of developing hemorrhagic complications in those who took ASA, warfarin, ASA + thienopyridine, ASA + warfarin or ASA + thienopyridine + warfarin. It turned out that the risk of hemorrhages while taking combination therapy increased slightly, but overall remained low. If in the ASA monotherapy group the risk of hemorrhagic complications requiring hospitalization was 0.03 cases per patient-year, then in the ASA and thienopyridine combination group it reached 0.07, in the ASA and warfarin combination group – 0.08, in the triple antiplatelet group therapy – 0.09 (1 out of 141 patients).
In a study by Z. Khurram et al. (2006) the addition of warfarin to dual antiplatelet therapy with ASA and clopidogrel increased the risk of hemorrhagic complications in patients undergoing PCI by 5 times. In another small study, D. DeEugenio et al. (2007) in the same category of patients, it was confirmed that the addition of warfarin to dual antiplatelet therapy is an independent risk factor for the development of serious hemorrhagic complications, and therefore the authors expressed the opinion that the strategy of triple antiplatelet therapy in patients with a low risk of thromboembolic events, most likely not advisable. In a study by P.P. Karjalainen et al. (2007) analyzed the differences between different strategies of long-term antiplatelet therapy for patients undergoing PCI - monotherapy with ASA, clopidogrel or warfarin, combinations of ASA + clopidogrel, ASA + warfarin, clopidogrel + warfarin, ASA + clopidogrel + warfarin. The addition of warfarin did not appear to affect the primary endpoint (death + infarction + need for revascularization + stent thrombosis at hospital discharge), but was associated with an increased risk of thromboembolic events after a year of taking the combination compared with treatment regimens without warfarin. At the same time, the risk of serious hemorrhagic complications during the use of warfarin-containing combinations increased 3 times. The authors concluded that the long-term prognosis of most patients taking warfarin-containing antiplatelet combinations after PCI is unfavorable, regardless of the nature of the combination.
The only randomized prospective trial comparing dual and triple antiplatelet strategies was WAVE (S. Anand et al., 2007). For patients with atherosclerosis obliterans of the arteries of the lower extremities who underwent ACS or PCI, the authors also found no benefit from the addition of warfarin to dual antiplatelet therapy in terms of the effect on major thromboembolic events (heart attack, stroke, cardiovascular death, severe ischemia of peripheral or coronary arteries with the need immediate intervention). Along with this, triple antiplatelet therapy caused a significant increase in the risk of hemorrhagic complications compared with dual antiplatelet therapy.
Thus, today there is very little evidence on the possibilities of using triple antiplatelet therapy; it was obtained in heterogeneous studies, each of which had a number of limitations, and therefore is very contradictory and does not give a clear answer to the question of the advisability of combining dual antiplatelet therapy and warfarin . Based on these data, it is not yet possible to determine the most appropriate indication for such aggressive antiplatelet treatment, but there is reason to believe that, perhaps, after appropriate randomized trials, it can be found to be quite effective and safe for patients at high risk of thromboembolic complications, such as those with atrial fibrillation. arrhythmia and ACS, especially for those who are indicated for PCI. However, it seems that for the majority of patients with ACS, the most rational option remains the use of dual antiplatelet therapy - along with increased effectiveness in the prevention of ischemic events, such a strategy in high-risk patients does not significantly affect the incidence of serious hemorrhagic complications, unlike warfarin-containing combinations.
Currently, there are clear practical recommendations for the use of dual antiplatelet therapy. According to the latest updates of European and American recommendations for the management of patients with segment elevation ACS ST and without it, the combination of ASA and clopidogrel is the most popular in the practice of managing cardiovascular patients, being indicated both in the conservative treatment of ACS (with or without thrombolysis) and in the case of PCI. Depending on the clinical situation, dual antiplatelet therapy can be used from 2 weeks (with a high risk of hemorrhagic complications) to 1 year; As for longer periods, the evidence base does not yet provide clear answers. The use of this combination is not indicated in patients who have suffered a stroke or TIA; in this situation, monotherapy with ASA or clopidogrel or a combination of ASA and modified-release dipyridamole is more preferable.
More aggressive antiplatelet therapy (antiplatelet agents + oral anticoagulant) may be warranted in patients at high risk of thrombosis and thromboembolic events. This primarily applies to people suffering from coronary artery disease, those who have undergone heart valve replacement or coronary artery stenting, as well as those who have had a stroke or TIA.
Experts have concluded that cautious use of combination antiplatelet therapy (warfarin with ASA, clopidogrel, or a combination of both) may be recommended when there is a high risk of thromboembolism and there are indications for both antiplatelet agents and oral anticoagulants (eg, atrial fibrillation and/or the presence of a thrombus in the cavities of the left heart in persons who have undergone ACS or PCI; in patients with mechanical prosthetic heart valves, especially with an increased risk of thromboembolism, etc). But it must be indicated that such therapy is associated with an increased risk of hemorrhagic complications. The doctor must carefully weigh the benefits and risks of such treatment before making a decision. In such patients, the international normalized ratio should be strictly maintained at 2.0-2.5 (predominantly), 2.0-3.0 or 2.5-3.5 depending on the clinical situation, and the doses of drugs used should be minimal . Similar recommendations are made in the ACC/AHA guidelines for the management of patients with segment elevation ACS. ST(2007) and without segment lifting ST(2007), ACC/AHA/SCAI guidelines for PCI (2007), ESC guidelines for the management of patients with non-elevation ACS ST(2007) and other advisory documents of international importance. Special precautions should be taken in relation to elderly patients and persons with risk factors for hemorrhagic complications.
In particular, in the guidelines of the European Society of Cardiology for the management of patients with elevation of the segment ST(2008) note that due to the lack of evidence obtained in prospective randomized studies, it is currently impossible to give clear recommendations on the indications for the use of triple antiplatelet therapy, but they believe that its feasibility should be considered in patients who have undergone coronary artery stenting for regarding elevation of the segment MI ST and at the same time having indications for oral anticoagulation (for example, atrial fibrillation). If the risk of hemorrhagic complications in such patients is high, it is preferable to use only an oral anticoagulant with a short course of antiplatelet therapy with clopidogrel alone.
In addition, many experts note that the level of hemorrhagic complications while taking warfarin (in combination with or without antiplatelet drugs) largely depends on the effectiveness of the surveillance system for patients taking this anticoagulant for a long time, and is minimal with well-established anticoagulant clinics with careful monitoring the state of hemostasis. Therefore, future studies addressing this issue should also consider the intensity of such monitoring and the severity of hemostatic control in patients taking warfarin in addition to antiplatelet agents.
Literature:
1. Hermosillo A.J., Spinler S.A. Aspirin, Clopidogrel, and Warfarin: Is the Combination Appropriate and Effective or Inappropriate and Too Dangerous? Ann Pharmacother 2008; 42 (6): 790-805.
2. Johnson S.G. Known knowns and known unknowns: Risks associated with combination antithrombotic therapy. Thromb Res 2008; 29.
3. Johnson S.G., Witt D.M., Eddy T.R., Delate T. Warfarin and antiplatelet combination use among commercially insured patients enrolled in an anticoagulation management service. Chest 2007; 131 (5): 1500-7.
4. Johnson S.G., Rogers K., Delate T., Witt D.M. Outcomes Associated With Combined Antiplatelet and Anticoagulant Therapy. Chest 2008; 133 (4): 948-954.
5. Buresly K., Eisenberg M.J., Zhang X., Pilote L. Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction. Arch Intern Med 2005; 11; 165 (7): 784-9.
6. Jennings L.K., Saucedo J.F. Antiplatelet and anticoagulant agents: key differences in mechanisms of action, clinical application, and therapeutic benefit in patients with non- ST-segment-elevation acute coronary syndromes. Curr Opin Cardiol 2008; 23 (4): 302-8.
7. Arjomand H., Cohen M., Ezekowitz M.D. Combination antithrombotic therapy with antiplatelet agents and anticoagulants for patients with atherosclerotic heart disease. J Invasive Cardiol 2004; 16 (5): 271-8.
8. Larson R.J., Fisher E.S. Should Aspirin be Continued in Patients Started on Warfarin? A Systematic Review and Meta-analysis. J Gen Intern Med 2004; 19 (8): 879-886.
9. Van de Werf F., Bax J., Betriu A. et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909-2945.
The main active ingredient of Curantil is dipyridamole, which helps to increase the production of interferon, a protein that has a pronounced antiviral effect. In this regard, Curantil can be used as a drug that increases the body's resistance to viral infections.
Curantil is available in tablets, dragees and solutions for intravenous administration. 
Curantil is prescribed to adults and children over 12 years of age who have vascular disorders in the brain, retina, heart, kidneys, and deep vessels of the extremities. In obstetric practice, it is used for circulatory disorders in the placenta and deterioration of the fetal nutritional conditions. 
Curantil can be taken during pregnancy; it does not have a negative effect on the fetus. However, in the 2nd and 3rd trimesters it should be taken with extreme caution and if there are clear indications for this. 
Curantil has quite a lot of analogues. Depending on the country and manufacturer, the drug is produced under the following trade names: 
