| BackgroundAspirin is currently the most important antiplatelet drug,and a large number of medical evidence has proven its role in the treatment and prevention of ischemic cerebral infarction.However,clinical practice found that not all patients can get consistent anti-platelet aggregation effects,and thrombosis still occurs in some patients taking aspirin which is known as aspirin resistance(AR).Thrombolastography(TEG),playing an important role in clinical medication,which can be effectively used to test AR.In recent years,with the increasing further study of the etiology of cerebral infarction,it can be seen that the most common types of cerebral infarction in clinical study is large-artery atherosclerosis(LAA)and small-artery occlusion(SAO),respectively indicating the cerebral infarction caused by large and small vascular lesions.Previous studies were mostly on LAA while SAO become the hot topic recently.However,there is rare study on whether AR can be the independent and dangerous factor of cerebral infarction relapse,on whether there is a difference between AR and stroke recurring in LAA and SAO patients with cerebral infarction were different,on relapse and non-recurrence,and on whether there is a difference between risk factors influencing LAA and SAO patients with cerebral infarction.Therefore,through testing the incidence of AR in LAA and SAO patients by using TEG with a long-term follow-up to observe the recurrence of cerebral infarction,this paper explores whether AR was an independent risk factor for LAA and SAO cerebral infarction,and whether there is a difference between AR and stroke recurrence in the cerebral infarction caused by large and small vascular lesions.This study also collected the general data of each group of patients,compared the risk factors of each group of patients.It is hoped that this study will develop a more rational antiplatelet therapy regimen for cerebral infarction patients,and provide more precise individualized treatment in the process of comprehensive prevention and treatment so as to provide some guidance for clinical medication todevelop more appropriate antiplatelet therapy.ObjectiveAfter an analysis on general information,TEG,test results and recurrence of stroke of 165 patients with LA A and SAO from Qilu Hospital of Shandong University.The purpose of this paper is to explore whether aspirin is the independent risk factors of cerebral infarction of the large and small vascular lesions,to explore the difference of AR and stroke recurrence in the cerebral infarction of the large and small vascular lesions,is to explore whether the risk factors of the two kinds of cerebral infarction are different,thereby providing individualized antiplatelet therapy for patients with cerebral infarction.Patients and MethodsBy using prospective cohort study method,165 first-episode patients with cerebral infarction were randomly divided into LAA group and SAO group according to the relevant inclusion criteria.All patients were given aspirin 100mg/d for 7 days and were given TEG test on the seventh day,and correspondingly,they were divided into AS group and AR group according to the test results.Then AR group patients changed to use clopidogrel 75mg/d treatment and were given TEG test on the 7th day again.Then,according to the test results or the patient's wishes,patients taking clopidogrel were excluded.Finally,all patients taking aspirin in the LAA and SAO groups were followed up for 12 months to observe the recurrence of stroke in both groups.Using SPSS23.0 software for statistical analysis,the measurement data complying with the normal distribution are indicated by using mean ± standard deviation(x ± s).Comparison between groups are tested by using two independent samples,count data using x2 test,and multi-factor Logistic regression analysis was used to assess the risk factors for ischemic stroke recurrence.The results of the TEG were determined by Kappa test with P<0.05 being defined as the difference having statistical significance.ResultsDuring the follow-up,6 patients(3.6%)were lost and 2 patients(1.2%)died.The comparison between the group with recurrence and group with non-recurrence:The proportion of patients with diabetes[47.9%(23/48)?28.2%(33/117),x2=5.898,P=0.015],Low density lipoprotein levels[2.70±0.68 mmol/L?2.40 ±0.74 mmol/L,x2=2.405,P=0.017],Uric acid level[320.09±73.72 umol/L.296?77±59.57 umol/L,x2=2.171,P=0.031]and AR patient ratio[60.4%(29/48)?6,8%(28/117),x2=20.037,P=0.000]increased and are independent risk factors of the recurrence of stroke.The comparison between LAA group and SAO group:Uric acid level[323.44±52.57 umol/L?298.01±65.19 umol/L,x2=2.153,P=0.033],hypertension[72.2%(26/36)?55.0%(71/129),x2=3.430,P=0.064]and AR patient ratio[38.9(14/36)?17.8%(23/129),x2=7.176,P=0.007]increased significantly.Considering uric acid?hypertension and AR as an independent risk factor for SAO stroke.Comparing SAO group,LAA group have higher TG level[1.63±1.19 umol/L?1.34±0.48 umol/L,x2=2.24,P=0.026],which considered to be independent risk factors of LAA stroke.In AR patients,the recurrence of SAO group was significantly higher than LAA group[86.7%(13/15)?48.5%(16/33),x2=6.286,P=0.012]and compared with patients with LAA,those patients with SOA had a higher risk of recurren ce.Conclusion1.AR significantly increased the risk of stroke recurrence,both in the LAA group and SAO group,should be considered as independent risk factors;2.Compared with patients in LAA group,patients in SAO group were more likely to develop aspirin resistance and had a higher risk of recurrence;3.Independent risk factors for stroke recurrence include diabetes,high levels of low-density lipoprotein levels,high uric acid and aspirin resistance;4.Independent risk factors for SAO cerebral infarction include:high uric acid,hypertension and aspirin resistance(AR).Therefore,the detection of AR and etiology types of cerebral infarction in patients will help clinicians to develop a more reasonable antiplatelet therapy for patients with cerebral infarction. |
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