Table of Contents
Evidence search.. 4
Literature Review.. 5
Summary and Conclusion.. 8
Clinical Recommendation.. 9
The table of the 5 studies……………………………………………………………………….9
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 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.
Myocardial infarction (MI) or acute myocardial infarction (AMI) is widely known as heart attack. It is caused by massive interruptions of the supply of blood to one part of the heart. Such interruptions have the effect of causing the heart cells to die. Rupture of atherosclerotic plaque results to blockage of coronary artery. What essentially causes infarction is the restriction in blood supply and shortage of oxygen supplied in the heart. If ischemia is left untreated for a long duration of time, damage of the heart muscle happens. In acute situations, it also leads to death. The slightest symptoms of acute myocardial infarction include consistent chest pain. In essence, it is the radiating of the left and the right side of the neck. Other common symptoms include shortness of breath, nausea, vomiting, sweating and anxiety. The anxiety is famously known as a sense of impending doom. The experience may be dictated by the gender of a person suffering from it. It is argued that women get fewer symptoms of myocardial infarction than men. An estimate of 22-64% of myocardial infractions are said to be silent. In this case, one suffers without any seeable symptoms (Tse, Lip & Coats, 2011).
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.
In this research, the patient intervention research method was adopted (PICO) to formulate a clinical question. In addition, the OVID, MEDLINE and PUBMED, 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.
According to Hutchison (2009), it is estimated that 7-10% of patients admitted with complications of myocardial infarction end up dying in hospital due to the development of cardiogenic shock. The resulting effect of cardiogenic shock is that it causes acute infarction. It has been discovered that the mortality of a patient is of importance in determining whether the attack of cardiogenic shock is imminent. The heart is subject of hypo-perfusion due to peripheral organ failure. Most cases associated with the diagnosis of myocardial infraction indicate are done through reperfusion therapy. Such reperfusion therapy includes thrombolysis (Tcheng, 2009).
Delays in performing the mechanical treatment procedure translate into worse outcomes. There are other treatment approaches that have been held to shorten the time for treatment of myocardial infarction. There are major treatments that alter myocardial metabolism hence substantially limiting and preventing the reperfusion injury. Research has shown that reperfusion bars the effective running of any treatment.
For the last 100 years, nitroglycerin has been advanced to treat cordial infarction. This is the element of nitroglycerin to be converted to nitric acid. This makes nitroglycerin reliable in the treatment of cardial infarction treatment. The entire process includes conversion of nitric oxide a process that takes place in the plasma membrane. The most remarkable part of the treatment is the fact that nitrates are converted into systematic conductance vessels. This has the effect of balancing the perfusion and the oxygen intake across the heart’s walls. However, the treatment through nitroglycerin is limited in nature, and studies have clearly shown that other drugs are better placed. In the very methods available for its administration, any contact with a syringe or any other polyvinylchloride plastic makes it lose activity. Undesired results such as hypotension may be occasioned when the filling pressures are low (Thompson, 2010).
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).
In the early 1970s, a great deal of attention was dedicated in the reduction and treatment of infarction. It was suggested by many patients that mortality of myocardial infarction was reduced due to overload reduction. Subsequent studies have clearly 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.
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
Literature Review on myocardial infarction treatment,
Intervention (I)/Outcome Measure (OM)
Aschenbrenner & Venable, (2009).
Qualitative Interpretative Design
4 clinical trials
Literature on the treatment of myocardiology presented in answers form.
High rate of reduction on myocardial infarction recorded by patients.
Cannon, Steinberg & Sharis, (2011).
7 studies conducted and left uninterrupted
Presentation of evidence on myocardial seeking to answer the question of other interventions. Use of staff, patient experience.
Evidence showed direct relationship between the period of treatment and the results seen
Descriptive Quantitative (cross-sectional survey)
Physicians answered questionnaires on myocardial treatment
Interventions contributions to the treatment of myocardial ranged from 40-68% across all physicians.
Iskandrian & Garcia (2008).
46 physicians intensive care units in a tertiary care center
Question answered on Use of cigarettes and alcohol
57% difference realized from the patients not using cigarettes and alcohol
Jacobson & Linden (2011)
Healthcare workers in a neonatal intensive care unit
Creation of awareness and educating the patients.
High levels of using life style interventions witnessed
I: Multi-modal campaign on the use of Plavix
52% reduction in myocardial death rates.
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