The Assessment Of The Antiplatelet Therapy For The High-risk CHD Patients With Clopidogrel Low-reactionunder The Assistance Of TEG

Background Large-scale clinical trials have shown that routine monitoring of the platelet function in patients with coronary heart disease(CHD) after percutanous coronary intervention(PCI) is not necessary. However, it is still unclear whether high-risk patients with CHD would benefit from the therapy which is guided by a selective platelet function monitoring.Objective This study sought to assess the benefit of the therapy guided by Thrombelastography(TEG) for high-risk patients with CHD.Methods 194 high-risk patients with CHD who would accept PCI treatment in the cardiovascular department of Xiamen First Hospital from Jan 2013 to Jan 2014 were selected. All the patients who have taken dual-antiplatelet drug were tested by TEG. According to the first test results, 116 patients with results MAADP < 47 mm were divided into‘ Effectiveness of Antiplatalet’. And the rest 78 patients were divided into ‘Ineffectiveness of Antiplatalet’. Patients of ‘Ineffectiveness of Antiplatalet’adjusted the drug under the advice of doctor. Those patients were divided into‘Effectiveness of Antithrombosis’ if their next TEG results show MAADP < 47 mm. And the others whose MAADP always be not up to standard were divided into ‘Ineffectiveness of Antithrombosis’. All patients took dual-antiplatelet drug for 1 year. At the same time,they were asked to make efforts to manage risk factors of cardiovascular disease: Healthy diet, exercise, weight management, non-smoking, blood pressure, LDL-C and blood glucose control. Observe the incidence of MACE and bleeding events after 1 year of PCI treatment.Results Follow-up of one year, 4 cases of ‘Effectiveness of Antiplatalet’ were lost to follow-up, 2 cases of ‘Ineffectiveness of Antiplatalet’were lost to follow-up. No significant differences were observed in the baseline clinical characteristics and interventional data between each group. The TEG image of the 176 patients who initially took clopidogrel showed MAADP was 40.9±15.1mm,and 60 cases of them existed clopidogrel low-reaction in varying degree(34.1%). And none of the patients who took ticagrelor existed ticagrelor low-reaction according to TEG results. There were statistical significance to compare the MACE between‘Effectiveness of Antiplatalet’(12.5%)and ‘Ineffectiveness of Antiplatalet’(30.2%)(χ2 =9.04, P < 0.05). 6 bleeding events happened in ‘Effectiveness of Antiplatalet’(5.4%), and 2 bleeding event happened in‘Ineffectiveness of Antiplatalet’(2.6%). There were not statistical significance between 2 groups(χ2 = 0.83, P = 0.47). Changed antiplatelet therapy according to TEG results, 36 patients were divided into ‘Effectiveness of Antithrombosis’, and the other 40 patients were divided into ‘Ineffectiveness of Antithrombosis’. 7 MACE(19.4%) happened in‘Effectiveness of Antithrombosis’.Eventually 16 MACE(40.0%) happened in ‘Ineffectiveness of Antithrombosis’. There were not statistical significance to compare MACE between 2 groups(χ2=3.79,P=0.08).Conclusion Part of patients with CHD who have accepted standard of antiplatelet therapy exist clopidogrel low-reaction. An individualized antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in high-risk patients with CHD after the first year of PCI treatment.