The Clinical Significance And Correlation Analysis Of Thromboelastography In The Recurrence Of Ischemic Stroke

ObjectiveThe purpose of this study was to investigate the clinical significance and correlation of thromboelastogram parameters on the recurrence of ischemic stroke by examining the thromboelastogram of the initial and recurrent groups,observing the antiplatelet drug resistance between the two groups,and comparing the differences of R value(reaction time),K value,? angle,Ma value(maximum blood clot strength),CI value between the two groups.Methods1.From January 2019 to December 2019,146 patients with acute ischemic stroke were admitted to the Department of Neurology of Subei people's Hospital and confirmed by head CT or head MRI.2.According to the number of stroke attacks,the patients were divided into the primary group and the recurrent group,and the smoking history,sex,age,the history of hypertension,diabetes,coronary heart disease,dyslipidemia and the history of taking antiplatelet drugs were collected;3.Routine antiplatelet medication on admission,aspirin 100 mg / D or clopidogrel 75 mg / D or aspirin 100 mg / D + clopidogrel 75 mg / D;continuation of the original oral medication on previous antiplatelet medication;4.Assessment of the degree of vascular stenosis,carotid artery plaque and its stability,associated leukoaraiosis,homocysteine,platelet count after admission 5.After taking antiplatelet drugs for one week,the thromboelastogram was performed;the phenomenon of antiplatelet drug resistance was observed in patients with ischemic stroke,and the differences of thromboelastogram indexes between the initial stroke group and recurrence group were compared,and the risk factors of recurrence of ischemic stroke were analyzed.Results1.There were 92 patients in the relapse group,66 males and 26 females,with an average age of 67.9 ± 11.5 years.There were 54 patients in the primary group,42 males and 12 females,with an average age of 64.8 ± 9.6 years.There was no significant difference in age and gender between the two groups(P > 0.05).2.There are different degrees of aspirin or clopidogrel resistance in patients with ischemic stroke,among which clopidogrel resistance is more common than aspirin resistance,the difference is statistically significant(P < 0.05);in all patients,the aspirin resistance,clopidogrel resistance in the recurrent group were higher than those in the primary group,the difference was not statistically significant.In patients with antiplatelet therapy alone,the aspirin resistance,clopidogrel resistance,MA-AA and ma-adp in the recurrent group were higher than those in the primary group,and the difference between MA-AA and MA-ADP was statistically significant(P < 0.05).3.Comparison of indexes of thromboelastography: the R value and K value of patients in the recurrence group were lower than those in the initial group,and the R value difference was statistically significant(P < 0.05);the ? angle,MA value and CI value of patients in the recurrence group were higher than those in the initial group,and the ? angle and MA value difference was statistically significant(P < 0.05)4.Single factor analysis showed that there was no significant difference in coronary heart disease,diabetes history,dyslipidemia,body mass index,neutrophil count and platelet count between the recurrent group and the initial group;the smoking rate,history of hypertension,degree of vascular stenosis,associated leukoaraiosis and homocysteine in the recurrent group were higher than those in the initial group.The difference was statistically significant(P < 0.05).Binary logistic regression analysis showed that MA value,associated leukoaraiosis,history of hypertension and degree of intracranial vascular stenosis were independent influencing factors for recurrence of ischemic stroke.P value and OR value were: MA value: OR=1.106,P=0.003;associated leukoaraiosis: OR=0.085,P=0.000;hypertension history: OR=0.300,P=0.036;vascular stenosis: moderate stenosis:OR=6.877,P=0.043;severe stenosis: OR=8.314,P=0.028;Conclusions1.Platelet drug resistance exists in patients with ischemic stroke,and clopidogrel resistance is more common than aspirin resistance,and antiplatelet drug resistance in recurrent group is more common than that in initial group.2.The R value of the patients in the recurrence group was lower than that in the initial group,and the ? angle,MA value,MA-AA and ma-adp in the recurrence group were higher than those in the initial group.3.Ma value,associated leukoaraiosis,history of hypertension and degree of intracranial vascular stenosis were independent factors of recurrence in patients with ischemic stroke.