| Purpose: Atherosclerosis is the pathological basis of coronary heart disease, and can lead to vascular endothelial injury, so as to activate platelet.Atherosclerosis is a chronic process, but thrombosis is an instant, fatal and disabling malignant event, we should pay more attention to and strengthen the prevention from the atherosclerotic thrombosis diseases. Anti-platelet therapy is an irreplaceable cornerstone for the treatment of coronary artery thrombosis. Platelet aggregation rate is an important indicator of platelet activity and used for the detection of platelet aggregation function.Most patients undergoing CABG in clinical are suffering from acute coronary syndrome and have received anti-platelet therapy recently, and coronary angiography shows severe coronary artery lesions or left main disease.The combination of aspirin and clopidogrel can reduce the incidence of ischemic complications, but it has the increased risk of bleeding after coronary artery bypass surgery. Therefore, for the high-risk patients who have applied clopidogrel and aspirin for anti-platelet therapy, it is suggested to withdraw the drugs for 3-5 days before CABG. In clinical, because surgeons do not have the objective indicators for the recovery of platelet aggregation rate, the arrangements for elective surgery can not often control the withdrawal time in the scope proposed in the guideline, even far more than 5days. Through dynamically monitoring the platelet aggregation rate change in 7 days after the withdrawal of the double-combined anti-platelet drugs in the patients with coronary heart disease While on Low-Molecular Weight Heparin anticoagulation, chooses safe and appropriate surgery time, effectively balances anti-ischemic benefits and bleeding risk. Materials and methods: control group: 45 cases of healthy people. the physical examination confirmed that the heart, liver and kidney, lungs and brain had no organic disease, have no sugar, fat metabolism. Not used anticoagulant antiplatelet drugs.in the last tow weeks. The subjects Include 31 male cases and 14 female cases, age ranges in 30～67 (45.77±9.38).Experimental group: 35 patients diagnosed as ACS,undergo coronary angiography, PCI is not suitable due to severe disease, and the patients agreed to be transferred to the Cardiac Surgery Department in our hospital for elective coronary bypass surgery, withdraw the double-combined anti-platelet drugs, and continue to apply the low molecular weight heparin for anticoagulation. The subjects Include 27 male cases (77.1%) and 8 female cases (22.9%), age ranges in 49-74 (62.46±6.223).Experimental methods: Control group: after getting up in the morning, not having breakfast, collect blood sample at elbow vein in a quiet state, Platelet aggregation rate is measured with ADP (10μmol/L) and arachidonic acid (10μmol/L)as inducers by means of whole blood impedance.Experimental group:The patients who are accurately diagnosed as ACS agree to be transferred to the Cardiac Surgery Department, and continue to apply the low molecular weight heparin for anticoagulation. Withdraw aspirin and clopidogrel, and collect blood sample at elbow vein at the fixed time before drug withdrawal and 1 day, 3 days, 5 days and 7 days after drug withdrawal. Platelet aggregation rate is measured with ADP (10μmol/L, 20μmol/L) and arachidonic acid (10μmol/L) as inducers by means of whole blood impedance.Statistical processing: SPSS 13.0 is adopted to make statistical analysis on the experimental data, and measurement data are expressed in mean±standard deviation ( x±s). The repeated measures engineered variance analysis was performed to achieve within-groups comparison at individual time points. P<0.05 indicates there is significant statistical difference.Results: Control group: In Healthy People, platelet aggregation rate at ADP10μmol/L is (8.11±3.83) ohm, platelet aggregation rate at AA 10μmol/L is (8.75±3.28)ohm. ADP 10μmol/L, and AA 10μmol/L platelet aggregation rate difference has no statistical significance (P=0.137).Experimental group:It can be known that time has significant effect on platelet values (F=125.64, P=0.0001). As time goes, platelet value difference in each group has statistical significance (F=187.29, P=0.0001), after ACS patients withdraw aspirin and clopidogrel, platelet aggregation rate at ADP 10um (t=10.559, P=0.001), ADP 20um (t=11.253, P=0.001) and AA 10um (t=15.988, P=0.001) presents upward trend from before withdrawal (baseline), to 1 day, 3 days, 5 days to 7 days after withdrawal upward trend under the induction .After taking into account the time factor, the platelet aggregation rate difference in the three dose groups has no statistical significance (F = 1.48, P = 0.234).At the 5th days after withdrawal, platelet aggregation rate at ADP10μmol/L is (6.83±3.249) ohm, platelet aggregation rate at AAμmol/L is (10.46±3.943) ohm, has reached the healthy adult respectively 84.2%, 119%. At the 7th days after withdrawal, platelet aggregation rate at ADP 10μmol/L is (9.89±3.323) ohm, platelet aggregation rate at AA 10μmol/L is (12.03±4.169) ohm, has reached the healthy adult respectively121%, 137%.Conclusions: Through monitoring platelet aggregation rate change after ACS patients withdraw the double-combined anti-platelet drug aspirin and clopidogrel, the experiment finds that the platelet aggregation rate rises from the baseline (before withdrawal) to 7 days after withdrawal. At the 5th day after withdrawal, the platelet aggregation gradually reaches stable level, but at the 7th day after withdrawal, the platelet aggregation is slightly higher than the normal range. Therefore, it is suggested to withdraw aspirin and clopidogrel for 5 days before coronary artery bypass surgery, while on the low molecular weight heparin for anticoagulation.
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