What is the best medicine for diabetes to prevent thrombosis

To be honest, there is no "best" drug for preventing blood clots in diabetics that is suitable for everyone. Currently, low-dose aspirin is the first choice with the most sufficient clinical evidence and the most widely used, but it is not suitable for everyone. The final drug you choose depends on your personal assessment of thrombosis risk and bleeding risk. What others use well may be a trap for you.

After all, people with diabetes are prone to blood clots. The essence is that long-term high sugar continues to damage the vascular endothelium, just like the inner wall of an iron pipe that has been corroded by sewage all year round. Platelets passing through are particularly prone to aggregation and clumps at damaged areas, causing problems wherever they are blocked. Low-dose aspirin can specifically inhibit the aggregation function of platelets without excessively interfering with normal coagulation. Decades of clinical follow-up data have confirmed that for people with diabetes who are at high risk of thrombosis, its benefits far outweigh the possible risk of bleeding.

Last week, I met a 54-year-old male patient in my clinic. He has been on diabetes for 12 years and has a history of high blood pressure and smoking. Last year, his physical examination revealed unstable plaques in his carotid arteries. He heard from relatives that aspirin hurts his stomach, so he secretly bought a so-called "pure natural anti-thrombotic health product" and ate it for more than half a year. When he came for a review this time, the plaque had grown by 0.2mm. , he always felt chest tightness, so we did a risk assessment for him. He was found to have a high risk of blood clots and a low risk of bleeding. He was prescribed 100mg aspirin enteric-coated tablets per day and told him to take it on an empty stomach in the morning. He was also prescribed some basic gastric mucosal protectants. This week he came for a follow-up visit and said that the feeling of chest tightness was gone, and he had no stomach pain or gum bleeding.

Patients often ask me, since clopidogrel is so much more expensive than aspirin, is it more effective? This is actually a big misunderstanding. Current domestic and foreign guidelines make it clear that only people who are intolerant to aspirin - for example, those who are allergic to aspirin, or those who have active gastric ulcers or a history of bleeding - will use clopidogrel as an alternative. There is no need to spend more money for the so-called "better". I once met a 29-year-old young man with diabetes who had no other high-risk factors except high blood sugar. He followed the trend and took clopidogrel for more than three months. His mouth was filled with blood when he brushed his teeth. His coagulation function was abnormal when he came to check, so he was asked to stop immediately. In this case, he does not need to take anti-thrombotic drugs regularly.

As for new oral anticoagulants such as rivaroxaban, only people with diabetes who are complicated by atrial fibrillation and have suffered from deep vein thrombosis need to use them. Ordinary thrombosis prevention is not needed at all. Don’t be fooled into buying them indiscriminately by online propaganda.

In fact, choosing anti-thrombotic drugs is similar to choosing rain boots. The higher the price and the more complete the functions, the better. If you usually walk on the cement road to and from get off work, ordinary rubber shoes are enough to wear, but if you insist on buying waterproof boots for professional mountaineering, they will be heavy and abrade your feet when walking. If you really want to consider taking anti-thrombotic drugs, don’t blindly buy them based on online guides. Ask your doctor to tell you whether you have high blood lipids, smoking history, family history of cardiovascular and cerebrovascular diseases, stomach problems, and frequent bleeding. The best drug for you will be chosen after assessing the risks.