Clinical Significance Of Detection Of Aspirin And Clopidogrel Resistance In Antiplatelet Therapy In Patients With Acute Cerebral Infarction

OBJECTIVE: To determine the clinical significance of anti-platelet drug therapy according to the test results by measuring the resistance of aspirin and clopidogrel in patients with acute cerebral infarction,and provide a reliable basis for individualized treatment and reduction of recurrent cerebral infarction.METHODS: A total of 136 patients with acute cerebral infarction who underwent clinical and imaging diagnosis of neurology in the First Affiliated Hospital of Hebei North University from February 2018 to August 2018 were enrolled.There were 69 patients in the experimental group and 67 patients in the control group.Both groups received fasting venous blood 3 days after taking antiplatelet drugs,with arachidonic acid(AA)and adenosine diphosphate(ADP).Inducing agent,using the PL-12 platelet function analyzer to determine the maximum aggregation rate of patients(MAR),AA MAR ? 55% is considered aspirin resistance(AR),ADP MAR ? 55% is considered chloropyridin Clopidogrel resistance(GPGR),the experimental group adjusted antiplatelet therapy for AR and GPGR patients,and the control group used conventional antiplatelet therapy.All patients were evaluated and recorded on NIHSS scores at admission and 3 weeks after treatment.All patients were re-examined for platelet aggregation after 3 weeks of treatment.Both groups were followed up for 6 months.The recurrence of cerebral infarction was recorded in both groups.RESULTS: 1)136 patients completed follow-up study.The experimental group consisted of 69 patients with an average age of 61.97±10.49,41 males and 28 females.The control group consisted of 67 patients with an average age of 60.83±10.32,38 males and 29 females.There were no significant differences in age,gender,hypertension,diabetes,hyperlipidemia,alcohol consumption,smoking,aspirin and clopidogrel resistance,and NIHSS scores between the two groups(P ? 0.05).2)Detection of aspirin resistance with AA as an inducer: Before adjusting the drug,there was no significant difference in AR rate and AA between the two groups(P>0.05).After the treatment group was adjusted for 3 weeks,the AR rate was statistically significant compared with the control group(test group: 5.80%;control group: 16.42%;P=0.048),and the difference between the AA average MAR and the control group was Statistical significance(test group: 35.32 ± 8.89;control group: 41.74 ± 8.99;P = 0.000).3)Detection of clopidogrel resistance by ADP as an inducer: Before adjusting the drug,there was no significant difference in GPGR rate and ADP between the two groups(P>0.05).After 3 weeks of treatment,the GPGR rate of the experimental group was statistically significant compared with the control group(test group: 8.70%;control group: 23.88%;P=0.016).The average ADP of the ADP was different from that of the control group.Statistical significance(test group: 36.86 ± 8.23;control group: 40.90 ± 7.53;P = 0.003).4)The experimental group adjusted the antiplatelet treatment according to the results of the aspirin and clopidogrel resistance test for 3 weeks,and the mean NIHSS score was statistically significant compared with the control group(test group: 2.42±0.67;control group: 3.71 ± 0.60;P = 0.000).5)The experimental group adjusted the antiplatelet treatment according to the results of aspirin and clopidogrel resistance test.After 6 months of follow-up,the experimental group had 2 cases of cerebral infarction recurrence,and the control group had 9 cases of cerebral infarction recurrence.The recurrence rate of cerebral infarction in the experimental group was compared with the control group.The difference was statistically significant(P=0.024).Conclusion: 1.MAR detected by AA as an inducer can respond to the resistance of aspirin;MAR detected by ADP as an inducer can reflect the resistance of clopidogrel.2.According to the results of aspirin and clopidogrel resistance test,the treatment plan can make the nerve function recovery better in patients with cerebral infarction,and the recurrence rate of cerebral infarction can be reduced.3.AR and GPGR have a higher incidence in patients with acute cerebral infarction.