| Objective:To realize types and application range of antiplatelet drugs in gerocomy population through the investigation and analysis of application status. Use Platelet function testing method (TEG) to explore the effective degree of antiplatelet drugs, so as to provide the basis for more efficient therapy. In order to provide convenient guidance for monitoring antiplatelet effect, we research the influencing factors of antiplatelet drugs combined with general clinical data and laboratory indexes. Set up evaluation cohort of adverse events after antiplatelet drug, prospectively analyse cardiovascular and cerebrovascular events after antiplatelet drugs and evaluate prostecdtive efficacy of different antiplatelet scheme.Method:Gerocomy population of 1637 people on physical examination in our hospital were enrolled in this cross-sectional study. Collected general clinical data and laboratory index. Voluntary data measuring TEG indexes for 955 people. Set up evaluation cohort of adverse events after antiplatelet drug, short-term follow up of cardiovascular and cerebrovascular events was done via telephone, interview at clinic and so on. Grouped on antiplatelet drugs situation:Aspirin, Clopidogrel, Dual-drug group and Non-drug group; according to the age of 80 divided into the old group and the super-aged group. Describes the analysis of application and effectiveness of antiplatelet drugs, and study the related clinical indicators influencing drugs efficacy, at last a prospective analysis of ardiovascular and cerebrovascular events after antiplatelet drugs is accomplished.Results:1.Age distribution in the clopidogrel group is the oldest (80.54±9.92), the current smoking (6.04%) significantly lowest, stroke (17.03%) significantly higher than the other three groups; history of coronary heart disease (79.01%) in the most obvious in dual-drug group.2.PLT level in aspirin higher than clopidogrel group (191.67±50.60 vs 178.67±46.45, P=0.03). Dual-drug group in blood lipid of TC (3.85±0.81, P<0.001), LDL-C (2.36±0.73. P<0.001)is lowest; FBG and HbA1c in dual-drug group increased significantly.3.In aspirin group AA% total rate is 48±9.3% near working and the super-aged group is better (58±8.3%); in clopidogrel group ADP% total rate is 63±8.2% within the scope of work; in dual-drug group AA%(51±6.5%)、ADP%(46±5.3%) are all within the scope of work, age stratification is of no difference. MA-ADP average is within the scope of the lowest risk, R value is in the normal range, age stratification is of no difference.4.According to different pharmacological inhibition pathway, there was no statistically significant difference among groups. The total rate in aspirin group is 17.66% and in clopidogrel group is 54.78%, between which the difference was statistically significant (P<0.001). In aspirin group the work and fine rate of the super-aged (20.61% vs 16.03%, 39.69% vs 21.94%, P<0.001) are higher than the old group. There’s the same trend in clopidogrel group(58.11% vs 48.78%,22.97% vs 19.51%, P=0.301), but no statistically significant difference.5.Analysis the influence factors of MA-ADP:the WBC (OR=1.262, P<0.001) is a risk factor for increased bleeding, PLT (OR= 1.006, P<0.001), eGFR (OR=1.016, P=1.016) and HbA1c (OR=1.358, P=1.358) are a risk factor for increased risk of thrombosis. Related factors in the old group similar to the general population, no obvious factors associated with super-aged group.6.Analysis the influence factors of R value:age (OR=1.036, P<0.001) is a risk factor of thrombosis, APTT (OR=1.090, P=1.090), LDL-C (OR=1.673, P=1.673) is a risk factor of bleeding risk. Related factors in the old group similar to the general population, similar to the whole set of related factors, in the super-aged group at the risk of thrombosis scope increased APTT (OR=0.884, P=0.884), HbA1c (OR=0.689, P=0.689) level reduce bleeding risk.7.Comparison of cardiovascular events between groups there are differences, but due to different sample size, short follow-up time and poor credibility, follow-up still need further observation.Conclusion:1.Clopidogrel is most widely used in the elderly in which smokers is fewest, and a stronger degree on platelet inhibition.2.Clopidogrel has more application in elderly stroke patients, most likely due to the dual antiplatelet increasing risk of hemorrhage;whereas in coronary heart disease (CHD) the standard therapy-dual antiplatelet-is of the most widely use.3.People use dual antiplatelet drugs are more combined use of lipid-lowering drugs, especially cholesterol-lowering drugs such as statins;also complicated with blood glucose abnormalities.4.In clopidogrel and dual-drugs group the average level of resistance to drugs achieve effective range, also that of aspirin group is nearly work scope. As for clopidogrel is widely used for the super-aged and in aspirin group the number of younger than 80-year-old is higher, compalicated with diabetes mellitus, hyperlipidemia, smokeing, non-responsers to drug slightly increase incuring less efficient.In the super-aged of single drug groups drug effect is better.The average of MA-ADP and R value are at the minimum risk range, the situation is more optimistic.5.According to different inhibition pathway, there’s no obvious difference in the effective number of people between aspirin and dual-drug group, as well as clopidogrel and dual-drug group. Effective number of people in clopidogrel group over half, is better than aspirin group, which efficiency fewer than half. In aspirin group the effective number of super-aged is more than the old group, as the same but not significantly trend in clopidogrel group. The overall situation agree with the level of inhibition rate.6.As for MA-ADP, compared with the lowest risk range(31-47 mm), at the risk of bleeding section(<31 mm), elevated WBC increased risk of bleeding, increased PLT bleeding risk reduction; at the risk of thrombosis section(>47 mm), PLT, eGFR, HbAlc level elevated, thrombosis risk increased. Related factors in the old group similar to the general population, no obvious factors associated with super-aged group.7.As for R value, compared with the normal value (6-8 min), at the risk of thrombosis section(<6 min), age increased risk of blood clots, APTT, HbAlc level elevated thrombosis risk reduction; at the risk of bleeding section(>8 min), APTT, LDL-C level elevated, risk of bleeding increased and elevated levels of PLT reduces bleeding risk. Related factors in the old group similar to the general population, in the super-aged group at the thrombosis risk section increased APTT, HbAlc level lower risk of bleeding.8.Set up evaluation cohort of adverse events after antiplatelet drug, people taking antiplatelet drugs divide into single-drug(aspirin and clopidogrel) and the dual-drugs, there are differences of the cardiovascular events incidence among groups, but duo to different sample size, short follow-up time and poor credibility, follow-up still need further observation. |
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