Today, a patient with cerebral infarction consulted me. His main problem was that after being discharged from the hospital, many problems occurred during the medication process. Please help me solve them.
The first question is that taking aspirin found that blood uric acid is as high as 520. Do you need to switch to clopidogrel ? First of all, we need to know whether this patient had elevated blood uric acid in the past.
If this patient had hyperuricemia before, taking aspirin is just a trigger. At this time, the first thing to do is to lower blood uric acid, so you can continue to take aspirin in the future.
If the patient has not had hyperuricemia before and the increase in blood uric acid caused by taking aspirin, then at this time, you will undoubtedly need to stop taking aspirin and switch to clopidogrel.
The second question is that blood uric acid is as high as 520. First, adjust it through exercise and diet, or persuade the medication? For patients who are diagnosed with hyperuricemia for the first time, we can actually reduce weight through exercise, avoid ingesting foods with high purine, reduce food intake of fructose , and pay attention to keeping warm in autumn and winter to reduce blood uric acid.
If this method is ineffective, then you need to take drugs that lower blood uric acid. One is a drug that promotes uric acid excretion, such as benbromalon , and the other is a drug that inhibits uric acid synthesis, such as allopurinol , febulista and other drugs.
The third question is, blood tests found that LDL cholesterol is 2.6. What should I do at this time?
For patients who have already suffered cerebral infarction, we suggest that everyone should control low-density lipoprotein cholesterol below 1.8 for a long time. It is obvious that this patient does not meet the standards. There are two main lipid-lowering plans to adjust for
: One is that if the statin dose taken by this patient is a small dose, it can be increased to a medium dose, so as to exert effective lipid-lowering effect. For example, 10 mg of atorvastatin, increase to 20 mg of atorvastatin.
Second, if the statin group taken by this patient is of medium dose and still cannot control lipid below the qualified range, a small dose of statin combined with erzemebu can be used, which is a powerful and effective lipid-lowering regimen. For example, 10 mg of atorvastatin 10 mg of ezemab can effectively control LDL below the qualified range.
Finally, the patient asked a question, is whether it is necessary to inject pcsk9 inhibitor and are the side effects of this drug great?
For patients who need to inject pcsk9 inhibitors, this drug can be injected with patients with refractory hyperlipidemia, such as patients who take moderate doses of statin or take small doses of statin combined with ezemeb, and still cannot reduce LDL cholesterol.
About is the side effects of pcsk9 inhibitor? At present, this drug is a new drug, and there are few reports of related side effects, but it may still lead to liver dysfunction and other related side effects, which require patients who are using this drug to attract attention.
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