| Platelet aggregation function is closely related to the cardiovascularevents. As an important and commonly used drug for antiplateletaggregation, Aspirin’s efficacy has been confirmed. However, since thereare individual differences when responding to the ASAantiplatelet therapy, more and more patients have aspirin resistance (AR)phenomenon, namely after oral standard dose aspirin antiplatelet therapyfailed to effectively inhibit platelet aggregation or failed to effectivelyprevent cardiovascular events. Of currently clinical treatment combinedmeditation was mainly employed to reduce the occurence ofcerebrovascular disease. However, In clinical practice, how the influencedrug combination against platelet aggregation? can it also effectivelyreduce the incidence of AR? how can clinical workers choose a moreeffective detection method that can accurately and rapidly diagnose theincidence of AR and accordingly give further treatment, which is rathercritical? Therefore, the main purpose of this study is to research the effectof aspirin combined with clopidogrel on AR in patients with coronaryheart disease (CHD) and to analyze the influence factors and clinicalsignificance of AR by employing two different kinds of mechanismdetection systems—optical Light transmittance aggregometry(LTA) as thestandard, comparative evaluation of LTA and the platelet functionanalyzer-100(PFA-100) which has not been registered domestically in thediagnosis of coronary heart disease in patients with AR consistency. Byreviewing the case history and the follow-up, the study attempted to analyze the relationship between the patients with combination therapyand AR to related clinical events.Cases of178patients diagnosed with coronary heart disease werecollected and randomly divided into aspirin group and combination groupwith89cases in each group. The two groups were both given oral aspirinenteric-coated tablets100mg/d, taking14days in a row, and thecombination group was also given oral clopidogrel75mg/d in addition.LTA and PFA-100were used to detect the platelet function respectively.The LTA with adenosine diphosphate and arachidonic acid as inducersand the PFA-100with collagen/adenosine diphosphate andcollagen/epinephrine as inducers were used to detect the incidence of ARin two groups of patients. According to the test results of traditional LTA,all patients were divided into aspirin resistance (AR) group and aspirinsensitivity (AS) group.Then compare the basic clinical characteristicsbetween the two groups and analyze the possible risk factors related toAR. And based on the results of platelet aggregation function, the degreeof the consistency on diagnosis of AR between two detection methodswas compared.LTA test results showed that, patients with aspirin resistance (AR) inthe total incidence was38.76%(69/178), that of aspirin sensitive (AS)was61.24%(109/178). Among them, in the combination group, theincidence of AR was30.34%(27/89), and that of AS was69.66%(62/89);and in the aspirin group, that of AR was47.19%(42/89), that of AS was52.81%(47/89). PFA-100test results saggested that, in the178patients,the incidence of AR was42.13%(75/178), that AS was56.87%(103/178).As a standard with test results of LTA, compared with aspirin group, theincidence of AR in the combination group was significantlyreduced(30.34%VS47.19%，P＜0.05), In combination group, twoinducer-induced average platelet aggregation rate was significantlydecreased, and the result of AA inductor is (24.21±2.82) vs (32.71±3.19) (P<0.05), and the average platelet aggregation rate induced by ADPdecreased even more significantly (48.08±2.45) vs (68.16±2.18)(P<0.01).By comparing the AR group with the AS group, it was found that thehistory of smoking and diabetes mellitus proportion significantlyincreased in AR group, the difference was statistically significant（62.3%VS45.9%、55.1%VS39.4%；P＜0.05).3months follow-up found thatthe incidence of myocardial infarction in combination group was lowerthan that in the aspirin group (9.0%VS21.3%；P＜0.05).and theincidence of myocardial infarction in AR group was higher than that inthe AS group (23.3%VS10.1%%；P＜0.05). Compared with LTA, theincidence of AR detected by PFA-100was slightly higher, but thedifference was not statistically significant (P＞0.05). The Kappa testshowed that, the two detection methods have a good consistency in thediagnosis of AR (Kappa=0.767).The major findings of this study include:1. Combination therapy ofaspirin and clopidogrel can effectively decrease the rate of plateletaggregation, reduce the incidence of AR, and can effectively reduce theincidence of thromboembolic events; AR may be one of the causes ofcardiovascular events；2. Smoking and diabetes patients is closely relatedto AR. They can be AR-increasing influencing factors for patients withcoronary heart disease;3. This study used advanced platelet functionanalyzer (PFA-100) and the traditional LTA having a rather high level ofconsistency in the diagnosis of aspirin resistance in patients with coronaryheart disease.Preliminary indication the PFA-100might be suitable toevaluate the platelet aggregation for clinical laboratory, and guide clinicaltreatment. |
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