| ObjectiveThe indexes of AA,ADP inhibition and other indicators of vascular restenosis after coronary angiography were measured by thromboelastogram,aiming to explore whether thrombo-elastogram monitoring AA,ADP inhibition rate and other indicators have guiding significance for anti-platelet therapy of coronary heart disease.MethodsCase-control study method was used to select 43 patients with coronary heart disease who were diagnosed as coronary heart disease by two or more coronary angiography from February to 2018 in Department of Cardiology,Second Affiliated Hospital of Fujian Medical University.Patients who were first diagnosed as having coronary artery disease and were implanted with stents by coronary angiography were selected for antiplatelet therapy.A mean of 8.5 months later,coronary angiography was performed again.The patients with aggravated vascular stenosis were included as restenosis group(n=19 cases).At the same time,patients undergoing first coronary angiography confirmed coronary artery disease and stenting were treated with antiplatelet therapy.On average,8.5 months later,coronary angiography was performed again.(n=24).Collect and count patient Clinical data from inpatient medical records,including general baseline data such as gender,age,smoking history,history of hypertension,history of diabetes,hyperlipidemia,etc.,as well as blood routine,blood clotting,thromboelastometry,and coronary angiography results.Observed whether there were differences in platelet aggregation inhibition rate,platelet aggregation,coagulation function indexes and whether the disease was associated with the two groups,and whether there was a correlation between the incidence of vascular restenosis,analysis of AA,ADP inhibition rate were not up to standard,both met the standard and both The relationship between the inhibition rate and 100% and cardiovascular adverse events and bleeding events was analyzed by logistic regression analysis to investigate the independent risk factors of coronary restenosis.Results1.There was no significant difference in the risk factors such as sex ratio,age,hypertension,diabetes,hyperlipidemia,and smoking history between the restenosis group and the control group(P>0.05).The two groups were comparable.2.Compared with the control group,the R value,MA value,Fib,DD and platelet counts in the restenosis group were smaller than those in the control group.The K value and Angle angle were slightly larger than those in the control group(P>0.05).3.In this study,the total number of patients with AA inhibition rate>75% was more than the total number of patients with ADP inhibition rate>75%.The platelet inhibition rate of AA pathway in both groups was >75%,which was sensitive to aspirin,and the AA inhibition rate met the target.The rate(ie effective for aspirin)in the restenosis group was higher than that in the control group,but the difference was not statistically significant(P>0.05);the ADP pathway platelet inhibition rate and the ADP inhibition rate compliance rate(ie effective for clopidogrel)in the restenosis group were Lower than the control group,and the restenosis group ADP inhibition rate <75%,but the difference was not statistically significant(P> 0.05).The data from this study showed that both groups were sensitive to aspirin and insensitive to some clopidogrel patients.4.MACE and bleeding events were observed during follow-up.A total of 17 MACE events occurred in 43 patients during the course of antiplatelet therapy.There were 9 cases(47.37%)in the restenosis group and 8 cases(33.33%)in the control group.There was no statistical difference.Significant(P>0.05);Bleeding events(all small bleeding,no major bleeding events)occurred in 12 cases,including 6(31.58%)in the restenosis group and 6(25.00%)in the control group,with no statistical difference.Significance(P>0.05).The rate of AA pathway inhibition and ADP pathway inhibition in the 12 patients with bleeding events were 93.342±3.190 and 85.383±7.168,respectively.5.Among the 36 patients whose AA and ADP inhibition rates both achieved,13 cases(36.11%)of MACE and 12 cases(33.33%)of bleeding events occurred.And the incidence of MACE in the restenosis group(46.67%)was greater than that in the control group(28.57%).The incidence of bleeding was compared with that in the restenosis group(40.00%)>Control There was no significant difference between the groups(28.57%)(P>0.05).6.There were 8/43 cases with AA and ADP inhibition rates all reaching 100%.Among them,4/8 cases(50%)of bleeding occurred in total,which was significantly higher than that of AA and ADP.The rate of ADP inhibition was lower than 100%.The probability(8/35 cases,22.86%),the difference was not statistically significant(P> 0.05).7.Logistic regression model was used to analyze the influencing factors of coronary artery restenosis after coronary angiography.The confounding variables including age,sex,smoking,Fib,D-dimer,platelet value,MA value,and platelet were adjusted in logistic regression model.Inhibitory rate and whether it is associated with diabetes,hypertension,hyperlipidemia,peripheral arteriosclerosis,etc.,in which the platelet inhibition rate is included in the model by whether the platelet inhibition rate is up to standard.The results showed that there was no significant difference in the rate of inhibition of AA and ADP pathways(P>0.05);there was a statistically significant difference in hyperlipidemia and peripheral arteriosclerosis(P<0.05),and it was an in-stent restenosis after PCI.For the independent risk factors,the OR values were 0.034(95% CI: 0.002-0.644),0.065(95% CI: 0.007-0.612).Among the 43 subjects,there were 34 cases(79.07%)of hyperlipidemia or peripheral arteriosclerosis or both coexisted alone,indicating that most patients with coronary heart disease had hyperlipidemia and peripheral arteriosclerosis.Conclusions1.The individualized differences in AA inhibition rates are large,and the variability in thromboelastogram values is large,which is not of great significance for guiding antiplatelet therapy.There was little change in platelet inhibition before and after the use of aspirin in antiplatelet therapy.However,the use of clopidogrel against platelets was more prone to failure.Therefore,the use of ADP inhibitory rate monitoring to guide the use of drugs more clinical significance.2.A total of 36/43 AA and ADP inhibition rates were achieved,and 13 MACE cases(36.11%)and 12 bleeding events(33.33%)occurred in the patients.This indicates that even if the platelet inhibition rate is up to standard in antiplatelet therapy in patients with coronary heart disease.Patients may also have MACE events.3.The number of cases in which the AA and ADP inhibition rates reached 100% was 8/43(18.6%),and bleeding occurred in 4/8 cases(50%),which was significantly higher than that in the control group.It shows that in the dual antiplatelet therapy,patients with AA and ADP inhibition rates up to 100% are more likely to have bleeding events.In summary,this study did not observe statistically significant results in monitoring the AA and ADP inhibition rates of patients with coronary heart disease by using TEG in guiding the use of antiplatelet drugs and preventing coronary restenosis,which was related to fewer observations.Need to further expand the number of cases in-depth study. |
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