The Role Of Antiplatelet Therapy Strategy Based On Thromboelastography On Clinical Outcomes In Patients With HR-NICE

Background:High-risk Non-Disabling Ischemic Events(HR-NICE)is unstable at early time,and prone to relapse to disabling ischemic stroke.Early antiplatelet therapy has important clinical significance during its treatment,but there are few studies on the detection of antiplatelet drugs in patients with HR-NICE.Objects:This study was designed to explore the role of antiplatelet therapy strategies based on thromboelastography(TEG)on clinical outcomes in patients with HR-NICE.Methods:A retrospective analysis enrolled 302 patients with HR-NICE admitted to the Department of Neurology from June 2018 to February 2019.According to performing TEG test or not after 5 days of dual antiplatelet therapy,we divided patients into TEG group and Non-TEG(N-TEG)group.N-TEG group was treated with aspirin plus clopidogrel dual antiplatelet for the first 21 days,and followed by clopidogrel for 90days;TEG group adjusted the resistant drug to cilostazol replacement therapy based on the test results,and selected antiplatelet which was not resistant or cilostazol for 90 days.Observe the incidence of aspirin and/or clopidogrel resistance.Compared the incidence of thrombotic and hemorrhagic events on the 14 th and 90 th day of treatment between the two groups,recording 90-day mRS score.Results:we enrolled 302 HR-NICE patients who completed the 3-month follow-up.The incidence of antiplatelet drug resistance(HTPR)was 50.6%(82/162)in the TEG group.The incidence of clopidogrel resistance(ADP-HTPR)is 3.6 times higher than that of aspirin resistance(AA-HTPR).On the 14 th and 90 th day of treatment,theN-TEG group had a higher recurrence rate of thrombotic events than the TEG group,and showed statistical differences on 90 th day(6.2% vs 12.9%;OR 0.446;95%CI0.199-1.001;P=0.046).However there was no significant difference in the recurrence rate of disabling stroke(mRS > 2 points)between the two groups(P=0.178).No hemorrhagic events occurred in either group.Comparison between groups in the TEG group,the HTPR group and the NTPR group,no significant difference was found(5.0% vs 7.3%;P=0.540).Conclusion:1.In patients with HR-NICE,the incidence of clopidogrel resistance was higher than aspirin resistance though the TEG.2.The individualized antiplatelet therapy based on TEG detection was safe and effective.