The Evaluation Of The Efficacy Of Dual Antiplatelet Drugs In Elderly Patients After PCI By Thromboelastography And The Analysis Of The Relevant Factors

Objective:To analyze the efficacy and related influencing factors of oral dual antiplatelet drugs after PCI in elderly patients with coronary heart disease.Methods:100 elderly patients with coronary heart disease who were detected by thrombelastography(TEG)at the first hospital of shanxi medical university from July2017 to July 2018 were selected.All the 100 patients were treated with combined treatment as aspirin and clopidogrel and grouped according to the platelet aggregation inhibition rate determined by TEG.Clopidogrel resistance(CR)was defined as the platelet inhibition rate induced by adenosine bisphosphate(ADP)< 30%.Aspirin Resistance(AR)was defined as the platelet inhibition rate induced by arachidonic acid(AA)< 50%.Dual resistance(DR)was defined as the coexistence of AR and CR.AR,CR and DR groups were classified as Antiplatelet drug Resistance group(ADR).Antiplatelet drug sensitivity(ADS)is defined as the platelet inhibition rate induced by ADP≥30% and that induced by AA ≥50%.The general clinical data and biochemical indexes of each group were statistically analyzed.Results:Among the 100 patients,56(56%)were ADR,and among them 13(13%)were AR,18(18%)were CR,25(25%)were DR.44(44%)were ADS.Comparison between ADRand ADS,the LDL-C,total cholesterol and glycosylated hemoglobin were statistically significant(P< 0.05).Comparison of AR、CR、DR、ADS,the age,glycosylated hemoglobin and fasting glucose of DR group were significant higher than those of other groups.LDL-C and total cholesterol in AR group compared with ADS group,glycosylated hemoglobin compared with DR group,and total cholesterol compared with CR group were statistically significant(P<0.05).The age,fasting glucose and glycosylated hemoglobin of CR group were statistically significant compared with that of DR group(P<0.05).The age,fasting blood glucose,LDL-C,total cholesterol and glycosylated hemoglobin of DR group were statistically significant compared with ADS group(P<0.05)).Logistic regression analysis of possible risk factors showed that old age,poor blood glucose control and high blood lipid were risk factors for antiplatelet drug resistance.Conclusion:TEG can reflect the efficacy of antiplatelet drugs through platelet inhibition rate,and timely detect elderly patients with resistance to aspirin and clopidogrel after PCI.Age,poor glycemic control and dyslipidemia are risk factors for antiplatelet drug resistance.Elderly patients with dyslipidemia are more likely to develop aspirin resistance.