血栓弹力图在颅内外动脉狭窄支架成形术前抗血小板聚集监测中的应用

Application of thrombelastograph in monitoring anti-platelet aggregation drugs in patients with intracranial and extracranial artery stenosis before stenting

  • 摘要: 目的 应用血栓弹力图(thrombelastograph,TEG)检测拟行颅内外动脉狭窄支架成形术患者,寻找术前最佳抗血小板给药时间,为手术时机把握提供参考。 方法 收集255例2012年12月-2014年12月解放军总医院神经外科收治的拟行颅内外动脉狭窄支架成形术患者,既往无服用阿司匹林和氯吡格雷的患者为A组(146例),服用阿司匹林和氯吡格雷达1周以上为B组(109例),两组均于入院当天口服阿司匹林100 mg+氯吡格雷75 mg,血栓弹力图检测服药后第1、3、5、7天的花生四烯酸(arachidonic acid,AA)和二磷酸腺苷(adenosine diphosphate,ADP)途径诱导的血小板抑制率。 结果 A组,与第1天相比,第3天的AA、ADP血小板抑制率无统计学差异(P> 0.05),第5天的AA、ADP血小板抑制率有统计学差异(P< 0.05)。B组,服药后第1天AA%为70.43%±15.32%,ADP%为36.52%±19.38%,已达到较好的抑制水平,与第3、5、7天相比,AA、ADP的血小板抑制率无统计学差异(P> 0.05)。 结论 既往无服用阿司匹林和氯吡格雷的患者,术前服用阿司匹林和氯吡格雷治疗延长至5 d后有较好的血小板抑制效果;既往服用阿司匹林和氯吡格雷1周以上的患者,术前服用阿司匹林和氯吡格雷抗血小板治疗,服药后第1天即有较好的血小板抑制效果。血栓弹力图可为颅内外动脉狭窄患者支架治疗时机提供参考。

     

    Abstract: Objective To detect patients with intracranial and extracranial artery stenosis with thrombelastograph (TEG), find the best time of taking drugs and provide reference for the surgery. Methods Two hundred and fifty-five patients admitted to Chinese PLA General Hospital from December 2012 to December 2014 who would undergo stenting were included in this study. They were divided into two groups, patients who hadn't taken aspirin and clopidogrel previously served as group A (n=146), and patients who had taken aspirin and clopidogrel for more than one week served as group B (n=109). Patients in these two groups took 100mg of aspirin and 75mg of clopidogrel on the day of admission. Platelet inhibition ratio induced by arachidonic acid (AA) and adenosine diphosphate (ADP) on 1 d, 3 d, 5 d, 7 d after taking drugs was detected by thrombelastograph. Results There was no significant difference in AA- and ADP-induced platelet inhibition ratios when compared 1 d with 3 d (P> 0.05), while it showed significant difference in AA- and ADP-induced platelet inhibition ratios when compared 1d with 5d in group A (P< 0.05). The AA- and ADP-induced platelet inhibition ratio on 1 d were (70.43±15.32)% and (36.52±19.38)%, respectively, which showed a good level of inhibition after patients taking the medicine for only one day after hospitalization, while it had no significant difference when compared with 3 d, 5 d, 7 d (P> 0.05). Conclusion If patients take aspirin and clopidogrel for more than 5 days before stenting without taking them previously, it can achieve a better platelet inhibition effect. Patients taking aspirin and clopidogrel for over 1 week before hospitalization will achieve a better platelet inhibition effect by taking them on 1d after hospitalization. TEG can provide references in stents treatment time for patients with intracranial and extracranial artery stenosis during stenting.

     

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