TEG在评价冠心病患者PCI术后抗血小板治疗效果及监测缺血、出血事件发生中的作用

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Abstract Objective To monitor the effect of antiplatelet drugs after percutaneous coronary intervention (PCI) in patients with coronary heart disease by thromboelastography (TEG), and to analyze its relationship with ischemic and hemorrhagic events after PCI. Methods A total of 300 patients with coronary heart disease diagnosed by the First People′s Hospital of Huizhou City of Guangdong Province ("our hospital" for short) and treated with PCI were collected from July 2017 to May 2018. All patients were treated with aspirin and clopidogrel for antiplatelet therapy. The arachidonic acid (AA) pathway platelet aggregation inhibition rate ≥ 50% defines Aspirin onset; the adenosine diphosphate (ADP) pathway platelet aggregation inhibition rate ≥ 30% defines Clopidogrel onset. According to the results of TEG AA/ADP inhibition rate, 200 cases were divided into Aspirin + Clopidogrel effective group (AA and ADP inhibition rates were up to standard), 30 cases in Aspirin ineffective group, 50 cases in Clopidogrel ineffective group and 20 cases in Aspirin + Clopidogrel ineffective group. The platelet inhibition rate and the total incidence of ischemic events within half a year were compared among the four groups. According to the results of the maximum clot intensification (MA-ADP) induced by adenosine diphosphate in TEG, the patients were divided into MA-ADP<31 mm group, 31 mm≤MA-ADP≤47 mm group and MA-ADP>47 mm group. The platelet inhibition rate and the total incidence of bleeding events were compared among the three groups. Results The platelet inhibition rate and the total incidence of ischemic events in the four groups were significantly different (P < 0.05). The platelet inhibition rate of aspirin + clopidogrel group was the highest, which was significantly higher than that of other groups (P < 0.05). The total incidence of ischemic events in aspirin + clopidogrel group was 35.00%, which was significantly higher than that in other groups (P < 0.05). The 300 patients were divided into MA-ADP < 31 mm group, 31 mm < MA-ADP < 47 mm group and MA-ADP > 47 mm group according to the results of TEG MA-ADP. The platelet inhibition rate and the total incidence of hemorrhagic events in the three groups were significantly different (P < 0.05). The platelet inhibition rate of MA-ADP > 47 mm group was significantly lower than that of other two groups (P < 0.05). The total incidence of hemorrhage events in MA-ADP > 47 mm group was only 5%, which was significantly lower than that in other two groups (P < 0.05). Conclusion For patients receiving antiplatelet therapy after PCI, monitoring with TEG can guide the adjustment of antiplatelet therapy and ensure the inhibition of platelet aggregation activity, thus reducing the incidence of cardiovascular adverse events.

Key words： Thromboelastography Coronary heart disease Percutaneous coronary intervention Aspirin Clopidogrel

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	DU Yubin LI Dan HUANG Sibing ZHANG Faning

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DU Yubin LI Dan HUANG Sibing ZHANG Faning. The role of TEG in evaluating the effect of antiplatelet therapy in patients with coronary heart disease after PCI and monitoring the occurrence of ischemia and hemorrhage events[J]. 中国医药导报, 2019, 16(11): 50-53.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I11/50

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