血栓弹力图在颅内动脉瘤支架辅助栓塞术前抗血小板监测中的应用

Application of thrombelastography in monitoring anti-platelet aggregation drugs in patients with intracranial aneurysms before stent-assisted embolization

  • 摘要: 目的 探讨血栓弹力图(thrombelastography,TEG)对颅内动脉瘤支架辅助栓塞术前患者血小板聚集抑制率的监测,为手术时机把握提供参考。 方法 收集2012年12月- 2014年12月解放军总医院收治的拟行颅内动脉瘤支架辅助栓塞术患者195例,根据病情及口服抗血小板药物的剂量,分成3组,其中未破裂动脉瘤为A组(75例),每天口服阿司匹林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;破裂动脉瘤患者,随机分为B组(60例)和C组(60例),B组每天口服阿司匹林200 mg +氯吡格雷150 mg,血栓弹力图检测服药后2 h、12 h、24 h、36 h的AA、ADP途径诱导的血小板抑制率;C组入院当天口服阿司匹林300 mg +氯吡格雷225 mg,血栓弹力图检测服药后2 h、8 h、12 h、24 h AA、ADP途径诱导的血小板抑制率。 结果 A组用药第3天AA、ADP血小板抑制率较第1天明显增高(P< 0.05)。B组用药第24 h的AA、ADP血小板抑制率较第2 h明显增高(P< 0.05)。C组用药第8 h的AA、ADP血小板抑制率较第2 h明显增高(P< 0.05)。 结论 颅内未破裂动脉瘤患者服用阿司匹林100 mg +氯吡格雷75 mg,3 d后可有较好的血小板抑制效果;颅内破裂动脉瘤患者服用阿司匹林200 mg +氯吡格雷150 mg,24 h后可有较好的血小板抑制效果;颅内破裂动脉瘤患者服用阿司匹林300 mg +氯吡格雷225 mg,8 h后可有较好的血小板抑制效果。血栓弹力图可为颅内动脉瘤患者支架辅助栓塞治疗时机提供参考。

     

    Abstract: Objective To investigate patients with intracranial aneurysms who will undergo stent-assisted embolization by thrombelastography (TEG) and provide references for the surgery. Methods One hundred and ninety-five patients admitted to Chinese PLA General Hospital from December 2012 to December 2014 who would undergo stent-assisted embolization were included in this study. They were divided into three groups according to their condition and doses of drugs. Patients with unruptured wide-necked aneurysms served as group A (n=75), and they took 100 mg of aspirin and 75 mg of clopidogrel every day. Splatelet inhibition rates induced by arachidonic acid (AA) and adenosine diphosphate (ADP) were detected at 1 d, 3 d, 5 d by TEG. Patients with ruptured aneurysms were randomly divided into group B (n=60) and group C (n=60). Patients in group B took 200 mg of aspirin and 150 mg of clopidogrel every day. Splatelet inhibition rates were detected at 2 h, 12 h, 24 h, 36 h by TEG. Patients in group C took 300 mg of aspirin and 225 mg of clopidogrel on the day of admission. Splatelet inhibition rates were detected at 2 h, 8 h, 12 h, 24 h by TEG. Results There were significant differences in platelet inhibition ratios in group A when compared 1 d with 3 d (P< 0.05); And significant difference was also found in platelet inhibition ratios in group B when compared 2 h with 24 h (P< 0.05), and group C when compared 2 h with 8 h (P< 0.05). Conclusion Patients with unruptured wide-necked aneurysms taking 100 mg of aspirin and 75 mg of clopidogrel before suegery can achieve a better platelet inhibition effect on 3 d after hospitalization. Patients with ruptured aneurysms taking 200 mg of aspirin and 150 mg of clopidogrel will achieve a better platelet inhibition effect on 24 hours after hospitalization. Patients with ruptured aneurysms taking 300 mg of aspirin and 225 mg of clopidogrel will achieve a better platelet inhibition effect on 8 hours after hospitalization. TEG can provide references for patients with intracranial aneurysm during stent-assisted embolization.

     

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