| ObjectiveTo investigate the different reactivity and influencing factors of aspirin and clopidogrel in patients with intracranial raptured aneurysm who were treated with stent-assisted embolization by thrombelastography,and to evaluate its correlation with severe complications such as intracranial hemorrhage and cerebral infarction perioperative,so as to provide guidance for the individualized treatment of antiplatelet drugs.MethodsClinical data of patients with intracranial ruptured aneurysm who were treated with stent-assisted embolization from January 1,2016 to December 31,2018 were prospectively collected from the department of Neurosurgery,Qilu Hospital,Shandong University.All patients were given oral loading dose of 300mg both aspirin and clopidogrel on the day of operation(generally 2h before procedure),postoperative venous blood samples of the patients were routinely taken for thrombelastography test.To evaluate different reactivity of patients who received aspirin and clopidogrel by TEG related parameters results,the platelet inhibition rate induced by arachidonic acid(AA)and adenosine diphosphate(ADP)were collected.According to the result of TEG,all patients can be divided into following subgroup:1.Aspirin hyperresponsiveness group(AA-induced platelet inhibition rates>95%),normal response group(AA-induced platelet inhibition rates range from 50%to 95%)and hyporesponsiveness group(AA-induced platelet inhibition rates<50%).2.Clopidogrel hyperresponsiveness group(ADP-induced platelet inhibition rates>90%),normal response group(ADP-induced platelet inhibition rates range from 30%to90%),hyporesponsiveness group(ADP-induced platelet inhibition rates<30%).The general data of patients,the proportion of different response groups and the postoperativel intracranial hemorrhage and cerebral infarction events were counted.SPSS24.0 statistical analysis software was used to analyze and process the data.ResultA total of 135 patients were enrolled in this study,including 47 males(34.8%)and 88 females(65.2%).Their ages range from 22 to 79,the average age of patientswas 56.77±10.94.The maximum amplitude(MA)of patients in this study ranged from 50.8 to 81.3mm,the mean maximum amplitude was(67.89+5.503)mm.The median platelet inhibition rate induced by arachidonic acid(AA)was 94.7%(84.0%-98.8%),there were 14 cases(10.4%)in the aspirin hyporesponsiveness group and 65 cases(48.1%)in the hyperresponsiveness group.The median platelet inhibition rate induced by adenosine diphosphate(ADP)was 84.3%(66.5%?96.9%),clopidogrel hyporesponsiveness group were 6 cases(4.4%),53 cases(39.3%)in the hyperresponsiveness group.The mean Body mass index(BMI)of the normal response group and the hyperresponsiveness group was higher than that of the hyporesponsiveness group(P=0.01<0.05),and there was a significant positive correlation between BMI and the reactivity of clopidogrel(rs=0.279,P=0.001<0.05).During hospitalization,a total of 6 patients(4.4%)had postoperative intracranial hemorrhage and 9 cases(6.7%)occured cerebral infarction.There was no statistically significant differences in the incidence of postoperative intracranial hemorrhage between the aspirin hyperresponsiveness group and the normal and hyporesponsiveness group(6.2%vs.2.9%,P=0.609),and no significant statistical difference in the incidence of postoperative intracranial hemorrhage between the clopidogrel hyperresponsiveness group and the normal and hyporesponsiveness group(5.5%vs.2.3%,P=0.328).There was no statistically significant difference in the incidence of postoperative cerebral infarction between the hyporesponsiveness aspirin group and the normal and hyperresponsiveness(14.3%vs.5.8%,P=0.236),and the hyperresponsiveness clopidogrel did not increase the incidence of postoperative cerebral infarction.The incidence of cerebral infarction after stent implantation in middle cerebral artery and anterior communicating artery complex is higher than that in other parts(P=0.001<0.05).The average usage of heparin in the postoperative cerebral infarction group was higher than that in the non-cerebral infarction group(P=0.04<0.05).Bivariate logistic regression analysis showed that heparin dosage using intraoperative was an independent risk factor for postoperative cerebral infarction(P=0.03,B:0.05,OR:1.051,95%CI:1.005-1.100).Conclusions1.Patients with aneurysmal subarachnoid hemorrhage,the maximum amplitude(MA),which reflecting overall platelet function,increased to varying degree.2.The incidence of clopidogrel resistance after ruptured intracranial aneurysm stent implantation was low.3.There were significantly positive correlation between clopidogrel reactivity and body mass index(BMI).4.There was no significant association of postoperative intracranial hemorrhage with hyperresponsiveness of aspirin and clopidogrel.The use of tirofiban did not increase the rnsk of postoperative intracranial hemorrhage.5.There was no significant correlation between postoperative cerebral infarction and hyporesponsiveness of aspirin and clopidogrel.The incidence of cerebral infarction alter stent implantation of middle cerebral artery and anterior communicating artery complex is higher than other parts.Heparin,which was used during operation,is an independent risk factor for postoperative cerebral infarction. |
PDF Full Text Request