| Objective: Coronary atherosclerotic heart disease of which atherosclerosis, plaque rupture and thrombosis are main pathological processes is considered as one of the important human lethal disease. Platelet, as the main composition of thrombosis, in thrombosis, plays a pivotal role especially in arterial thrombosis and microvascular thrombosis. Therefore, the appliction of antiplatelet drugs have become as primary clinical means, are used clinically for the prevention and treatment of CAD, and achieved a significant curative effect. Nowadys, antiplatelet drugs have a wide range, including epoxygenase inhibitors, P2Y12 receptor inhibitors, GPⅡb / Ⅲa receptor antagonists and so on; P2Y12 receptor inhibitors include prasugrel, ticagrelor, clopidogrel, clopidogrel is most commonly used for antiplatelet therapy. And the dual antiplatelet therapy-aspirin combined with clopidogrel, has become the elementary treatment for ACS. In the research of aspirin intaking time, a randomized cross-over design trial, conducted by Bonten etc. showed that platelet aggregation are inhibited more obviously at bedtime than awakening time, because the platelet activity is higher on awakening time, intaking aspirin at bedtime can reduced the morning peak of the platelet aggregation.wether the intaking time of clopidogrel have an effect on platelet activity is rare at home and abroad, And The purpose of the present study is to explore the optimal intaking time of clopidogrel in order to achieve maximum efficiency, and to provide the guide for clinical reasonale drug use.Methods:①collect patients admitted to the second hospital of hebei medical university during 2014.01-2014.12, diagnosed with UA.1) According to《2012 with unstable angina and non-ST segment elevation myocardialinfarction treatment guidelines》;2) ages between30-70 years; 3)not taking clopidogrel before or patients stopping clopidogrel with at least 7 days. 4) Have no clopidogrel resistance(the definition of clopidogrel resistance: platelet aggregation inhibition rate spurred by 5 umol/L ADP-the decline in absolute value between platelet aggregation rate after the treatment and baseline is less than or equal to 10%). ②According to random number table, the cases are divided into two groups, namely the daytime and the night groups.There are 45 cases in the daytime group, with 19 male, and 26 female; there are 46 cases in the night groups, with 25 male, and 21 female. ③The patients in daytime groups take medicine on awakening time, 75mg/day; the patients in night groups take medicine at bedtime, 75mg/day. ④Monitoring indicators are platelet aggregation rate and hemorrhagic events for 7 days.(According to PLATO-defined major bleeding:fatal hemorrhage; intracranial hemorrhage; pericardium hemorrhage; hypovolemic shocks or severe hypotension caused by bleeding which are needed vasopressors or surgical therapy;decreased hemoglobin levels greater than or equal to 5.0 g/dl; infusion of at least 4 units of red blood cells; To cause clinically significant disabled bleeding-such as intraocular hemorrhage with permanent blindness; bleeding with hemoglobin at least drop of 3.0 g/dl, but < 5.0 g/dl; bleeding needed to infusion of 2-3 units of red blood cells.Secondary bleeding: to require any medical intervention but do not accord with standard of major bleeding). ⑤The patients in the daytime group and night group are required to draw blood 3ml by the elbow vein before taking the medicine, after 3 days, and after 7 days,and send it to laboratory to assay platelet aggregation rate by LTA within 3 hours. Afterward, record the data,and calculate the inhibition of platelet aggregation rate in order to eliminate clopidogrel resistance. The experimental data will be obtained using SPSS 13.0 software for statistical analysis. Continuous variables are expressed as the arithmetic mean and standard deviation(`X±SD) or median and interquartile range, T test orrank sum test are used to compare the Continuous variables between two groups;Discrete variables are expressed as percentage and rate, compared with the X2 test or Fisher’s Exact Test. The repeated measures engineered variance analysis was performed to repeated measurement design datas "P<0.05" is considered statistically significant.Results: 1 The characteristics of the baseline data 45 cases are collected in daytime group, and 5 patients with clopidogrel resistance are filtere, according to the definition of clopidogrel resistance, with the proportion of 11%. 3 cases are male and the others are female;46 cases are collected in night group. 6 patients with clopidogrel resistance are filtered,with the proportion of 13%. 3 cases are male and the others are female. After the elimination of clopidogrel-resistance cases, the daytime group has 40 patients remained, with 16 male, and 24 female. The night group has 40 patients remained, with 22 male, and 18 female. The differences of the baseline between the two groups including gender, age, weight, history of hypertension, hyperlipidemia, family history of heart disease, platelet count, liver function between the two groups, has no statistical significance(P > 0.05). 2 The comparison of platelet aggregation rate 2.1 The comparison of platelet aggregation rate at different times : platelet aggregation rate at different time points(before taking the medicine, after 3 days, after 7 days) was a statistically significant difference(P < 0.05),that is,different time points have an effect on platelet aggregation. The comparison within groups(the platelet aggregation rate at different time were pairwise comparisons), The results showed that the differences were statistically significant(P <0.05). The platelet aggregation rate before taking the medicine was 76.85%± 12.96%. The platelet aggregation rate after 3 days was 60.05% ± 11.95%; the platelet aggregation rate after 7 days was 50.15% ± 15.83%, platelet aggregation rate gradually decreased, which wasstatistically significant; likewise, in the night group,platelet aggregation rate gradually decreased as well, and this is statistically significant. 2.2 the comparison of platelet aggregation rate between groups The platelet aggregation was no statistically significant difference between the two groups(P>0.05), that is, clopidogrel of intaking time has no effect on platelet aggregation. 2.3 The factors between time and clopidogrel of intaking time have no significant interaction effect, that is, the varition of platelet aggregation rate caused by the factor of time and grouping does not work with each other. 3 The patients in daytime group and night group have no PLATO-defined major bleeding and minor bleeding.Conclusions: 1 There is no significant correlation beween platelet aggregation rate and clopidogrel taking time. 2 the platelet aggregation rate reduced gradually with the extension of medication time in 7 days, showing that medication adherence is important to antiplatelet therapy. |
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