A Comparative Study Of Clopidogrel-Hydrogen Reduction And Direct Deactivation After Intracoronary DES Implantation After 12 Months

Objective: Previous studies have shown that a sudden discontinuation of long-term oral administration of clopidogrel hydrogen sulfate may lead to an increase in platelet reactivity,and thus the risk of thrombotic events may increase.In this study,the platelet aggregation rate and the incidence of adverse cardiovascular events were measured to compare the effect of reducing discontinuation with direct discontinuation of clopidogrel hydrogen sulfate on platelet function and ischemic events.Methods:1.We selected patients who were diagonosed with acute coronary syndrome(ACS)and underwent DES implantation from October 2015 to October 2016 in The Second Hopsital of Hebei Medical University.All patients received clopidogrel hydrogen sulfate plus aspirin for 12 months as dual antiplatelet therapy.Then these patients were randomized to either direct discontinuation group(group A)or dose-decreasing discontinuation group(group B).We performed three blood samplings and three adverse cardiovascular events.All patients were examined for platelet aggregation rate as baseline level(0 weeks)on the day of enrollment,and then platelet aggregation rate was assessed using a multi-electrode aggregometer at 2weeks and 4 weeks after deactivation or start of reduction.The incidence of adverse cardiovascular events was followed at 4 weeks,8 weeks,and 12 weeks after discontinuation or start of reduction.Among them,the patients who were lost of follow-up or with the incomplete data were removed in the study,a total of 125 patients were enrolled in the study,61 patients in the group A and 64 patients in the group B.2.Statistical analysis of the data was performed using SPSS 25.0statistical software.The measurement data that conforms to the normaldistribution are expressed by the mean ± standard deviation,and the measurement data that does not conform to the normal distribution are expressed by the median(upper quartile,lower quartile).The t-test is used for the state distribution,and the non-parametric rank sum test is used for the non-conformity distribution.The count data are expressed as a rate or percentage,and the count data between the two groups are compared by chi-square test.Repeated measures analysis of variance was used to explore the changes of platelet aggregation rate with time after drug withdrawal and the difference between the experimental group and the control group.Set the inspection level P=0.05.Results:1.The platelet aggregation rate after clopidogrel withdrawal did not change with time,and there was no time-group interaction effect.There was no significant difference in platelet aggregation levels between the two groups after discontinuation(Fmeasure time=2.435,P=0.100,Fmeasure time*group=0.158,P=0.815,Fgroup=0.415,P=0.520).2.The incidence of adverse events in the control group was 1.6%,and the incidence in the experimental group was 0.0%.There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusions:In patients with acute coronary syndrome after DES implantation,there was no significant difference in the effect of clopidogrel reduction and direct cessation on platelet aggregation rate and incidence of cardiovascular adverse events after 12 months of oral dual antiplatelet drugs.