Application Of The Thrombelastography As A Guidance To Antiplatelet Therapy For ACS Patients Duringthe Perioperative Period Of PCI

Objective:To evaluate the application of thromboelastography as a guidance for prescription and prognostic diagnosis on ACS patients at PCI perioperative period. Methods:Patients diagnosed as acute coronary heart disease and received PCI treatment at cardiovascular hospital, Shanxi.from February 2014 to February 2015 were randomly selected and divided into 3 treatment groups. Conventional group: patients treat with conventional aspirin and clopidogrel antiplatelet drugs(n=31) without thrombelastogram monitoring; the other 2 groups were performed thrombelastogram prior to treatment. According to the results, patients who were highly sensitive to clopidogrel were treated with conventional clopidogrel aspirin and clopidogrel antiplatelet(high response group, n=30); and those who were not sensitive to clopidogrel were treated with ticagrelor and aspirin antiplatelet(low response/ticagrelor group, n=31). All 3 groups were subjected to long-term follow up after being discharged from the hospital and the incidence of major adverse cardiovascular events(MACE) within 1 year was compared among the three groups. Results:1、1 year’s follow-up shows that:the incidence of the major adverse cardiovascular events(MACE) in high response group and ticagrelor group which have been monitored with thrombelastogram was significantly lower than that of the conventional group(P < 0.05), which was not monitored by the thrombelastogram prior to treatment. The difference was statistically significant.2、There were no statistical differences(P>0.05) in the incidence of the mojor adverse cardiovascular events(MACE) between the high response group and ticagrelor group which have been monitored with thrombelastogram after 1 year’s follow-up.3、Smoking may be an independent risk factor for the low response to clopidogrel. Conclusion:1、The long term prognosis of the patients whose antiplatelet treatment strategy was selected under the guidance of the thromboelastography(high response group and ticagrelor group) was significantly better than conventional group, whose treatment strategy was determined without the thromboelastography guidance.2、The long-term prognosis had no significant difference between clopidogrel low-response group(ADP < 50%), whose treatment were replaced by ticagrelor and clopidogrel high response group(ADP ≥50%).3、The application of thromboelastography provides significant clinical guidance in determining the antiplatelet therapy in ACS patients at perioperative period of PCI.4、Smoking may be a risk factor for low response to clopidogrel after PCI.