TEG-PM (Thrombelastography Platelet Mapping) For The Mono-antiplatelet Medication Following Duel-antiplatelet Treatment In Patients With TIA And Minor Stroke

Objective:To evaluate the clinical significance of TEG-PM-based mono antiplatelet medication screening for long-term(> 90 d)ischemic event prevention in patients with minor stroke or TIA.Methods:Patients with mild stroke or TIA in our hospital's HIS system during September 2016 and December 2019 were searched.They were divided into thromboelastography(TEG)group and non-thromboelastography(Non-TEG)group according to whether the thromboelastography test results was used to guide medication.Sub-grouped by stroke type and vascular condition: Minor Stroke(MS)group,Transient Ischemic Attack(TIA)group,Symptomatic Intracranial Arteriosclerotic Stenosis(ICAS)group,and non-Asymptomatic Intracranial Arteriosclerotic Stenosis(Non-ICAS)group,each of which is divided into TEG subgroup and Non-TEG subgroup.The incidence of ischemic events and anti-platelet drug-related economic expenditures in different groups over a long period(90 days to the end of the follow-up period)were compared.Results:A total of 515 patients were included in this study(563 cases in total,48 cases lost to follow-up),342 of them were male,and the age was in 60 ± 12 years.In the TEG group(223 patients)compared with non-TEG(292 patients),the main end point event(ischemic stroke)occurred in 11.2% and 13.4%(OR=0.54,95% CI: 0.49-0.76,p<0.01))during the mean follow-up period(582 ± 13 days),the number of ICAS was 2 and 1 respectively.No symptomatic intracranial hemorrhage was observed in either group during the follow-up period;There were 3 cases and 1 case of bleeding in other parts in the TEG group and Non-TEG group,respectively.No fatal bleeding events were observed in the two groups during the follow-up period.There was no significant difference in the results between MS and TIA subgroups in TEG group and non-TEG group.In the ICAS group,compared with the non-TEG subgroup and the TEG subgroup,the main endpoint events occurred in 22.1% and 18.7%(OR=1.38,95% CI: 1.11-1.58,p<0.01);there is one case of ICAS in both of the two subgroup.No non-symptomatic intracranial hemorrhage was observed.The number of bleeding in other parts was 2 and 1 respectively.Compared with the non-TEG subgroup,the incidence of primary endpoint events was 8.4% and 7.6%(OR=1.41,95% CI: 1.02-1.63,p<0.01);TEG subgroup occurred in 1 case of ICAS,and no asymptomatic intracranial hemorrhage was observed;the incidence of bleeding in other parts was one in TEG subgroup;No fatal bleeding was observed.Conclusion:Compared to random long-term application of antiplatelet drugs,the application of thromboelastography guided mono antiplatelet medication can reduce the long-term recurrence risk of ischemic strokes in patients with minor stroke or TIAs.