Efficacy of taking ACE inhibitors and direct anticoagulants for coronary heart disease
Efficacy of an ACE inhibitor (ACE inhibitor) in coronary heart disease (CHD). There is ample evidence of the benefits of an ACE inhibitor in individuals with a high risk of coronary heart disease (CHD). After myocardial infarction (MI), an ACE inhibitor is associated with a 7% decrease in mortality by day 30 of the disease. Among patients with myocardial infarction with low EF, the decrease in total mortality is 26%.
A meta-analysis of 6 randomized controlled trials showed that long-term therapy with an ACE inhibitor reduces the risk of major clinical outcomes by 22%. The NORE study revealed that the benefits of an ACE inhibitor apply to patients with CHD and DM, even in the absence of LV dysfunction. The results of the CHARM (Candesartan in Heart Failure Assessment of Mortality and Morbidity) study showed that the use of ARBs of candesartan in patients with HF can prevent 1 death in the treatment of 63 patients, 1 first hospitalization for HF in the treatment of 23 patients and 1 new case of diabetes in the treatment of 71 patients.
Efficacy of direct anticoagulants for coronary heart disease (CHD). Per os anticoagulants prevent embolic complications in patients with prosthetic heart valves and atrial fibrillation. The role of the anticoagulant as an independent drug or in combination with aspirin in the secondary prevention of patients with coronary heart disease (CHD) is less defined.
The results of randomized controlled trials are ambiguous, anxious is such a side effect (PE) of anticoagulants as bleeding.
The 1999 meta-analysis provided comprehensive data on the different efficacy of treating patients with cardiovascular disease (CVD) with anticoagulants of varying intensity in combination with aspirin or aspirin alone as compared with placebo. In this analysis, it was shown that treatment with moderate or high intensity anticoagulants reduced the incidence of MI and MI compared to placebo, but increased the risk of hemorrhage.
The combination of low-intensity anticoagulants with aspirin did not lead to an increase in efficacy compared with aspirin alone, while a combination treatment with moderate-to-high-intensity anticoagulants with aspirin gave promising results. However, a recent analysis included the results of more recent studies of CHAMP (Cardiac Hospitalization Atherosclerosis Management Program), LoWASA (Low-dose warfarin and aspirin), WARIS II (Warfarin-Aspirin Reinfarction Study) and ASPECT-2 (Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis) led to the conclusion that moderate to high intensity anticoagulants should not be used routinely as an alternative or aspirin supplement in patients with acute coronary syndrome (ACS) because of the increased risk of bleeding.
Additional clinical studies are needed comparing the effectiveness of a combination of anticoagulants with clopidogrel. c) Recommendations. Aspirin should be used to treat all patients with various forms of coronary artery disease. The combination of aspirin with another anti-platelet drug, such as clopidogrel, should be used only in acute situations when treating patients at very high risk.
β-AB should be considered for the treatment of patients after MI or with HF. An ACE inhibitor should be considered a standard cost-effective therapy for patients with low EF and other high-risk patients. All three classes of the drug are recommended by AHA, ACC and ESC for secondary prophylaxis. The USPSTF recommended aspirin for primary prophylaxis in patients with a 5-year risk of CVDs> 3% (equivalent to 6% of a 10-year risk).
Per os anticoagulants, although they are clearly useful in the treatment of patients with AF and certain prosthetic heart valves, are not recommended for the general prevention of KBS-related events.