Background Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention.Recent studies have indicat...Background Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention.Recent studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet aggregation.Methods Thrombelastograph （TEG） determinations were used to evaluate the effect of antiplatelet therapy.According to the results,90 patients were divided into three groups and given different doses of aspirin and clopidogrel.Thirty patients with both an inhibition rate of aspirin 〉50% and an inhibition rate of clopidogrel 〉50% were defined as the control group.Sixty patients with an inhibition rate for aspirin 〈50% and an inhibition rate for clopidogrel 〈50% were defined as the resistance group.Patients in resistance group were randomly assigned to be given a routine dose （100 mg aspirin plus 75 mg clopidogrel per day,which we called a resistance plus routine dose group,R＋R） and a loading dose （200 mg aspirin and 150 mg clopidogrel per day,which we called resistance plus loading dose group,R＋L） of antiplatelet therapy.A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic events.Results After 6 months of antiplatelet therapy,the inhibition rate of aspirin in the R＋L group increased from （31.4±3.7）% to （68.6±7.1）%,which was significantly higher than that in R＋R group,（51.9±8.2）% （P 〈0.01）.The inhibition rate of clopidogrel in the R＋L group increased from （22.1±3.8）% to （60.2±7.4）%,which was significantly higher than in the R＋R group,（45.9±4.3）% （P 〈0.01）.The occurrence rates of cardiovascular ischemic events,stent thrombosis,recurrent unstable angina and myocardial infarction in the R＋R group were 20%,36% and 17%,respectively.Occurrence was significantly increase展开更多
文摘Background Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention.Recent studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet aggregation.Methods Thrombelastograph （TEG） determinations were used to evaluate the effect of antiplatelet therapy.According to the results,90 patients were divided into three groups and given different doses of aspirin and clopidogrel.Thirty patients with both an inhibition rate of aspirin 〉50% and an inhibition rate of clopidogrel 〉50% were defined as the control group.Sixty patients with an inhibition rate for aspirin 〈50% and an inhibition rate for clopidogrel 〈50% were defined as the resistance group.Patients in resistance group were randomly assigned to be given a routine dose （100 mg aspirin plus 75 mg clopidogrel per day,which we called a resistance plus routine dose group,R＋R） and a loading dose （200 mg aspirin and 150 mg clopidogrel per day,which we called resistance plus loading dose group,R＋L） of antiplatelet therapy.A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic events.Results After 6 months of antiplatelet therapy,the inhibition rate of aspirin in the R＋L group increased from （31.4±3.7）% to （68.6±7.1）%,which was significantly higher than that in R＋R group,（51.9±8.2）% （P 〈0.01）.The inhibition rate of clopidogrel in the R＋L group increased from （22.1±3.8）% to （60.2±7.4）%,which was significantly higher than in the R＋R group,（45.9±4.3）% （P 〈0.01）.The occurrence rates of cardiovascular ischemic events,stent thrombosis,recurrent unstable angina and myocardial infarction in the R＋R group were 20%,36% and 17%,respectively.Occurrence was significantly increase
文摘目的探讨血栓弹力图(thrombelastograph,TEG)联合常规凝血指标在急性胰腺炎(acute pancreatitis,AP)发病早期临床救治中对病情严重程度评估的意义。方法选取2015年8月至2016年8月兰州军区兰州总医院发病24 h内收治的急性胰腺炎患者73例为研究对象。依据中华医学会急性胰腺炎诊治指南(2014版)将患者分为轻症组33例(MAP组)、中重症组26例(MSAP组)和重症组14例(SAP组)。完善相关检查,检测常规凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(DD)],描绘TEG[血凝时间(R)、血块成型时间(K)、α角、血块强度(MA)]。记录24h急性生理与慢性健康评分Ⅱ(acute physiology and shronic health evalu-ationⅡ,APACHEⅡ)及48 h改良Marshall评分,分析监测指标在3组中的变化。结果中重症组较轻症组PT、APTT、FIB、DD的水平轻度升高(P>0.05);与中重症组及轻症组比较,重症组PT、APTT、FIB和D-D均显著升高(P<0.05)。3组R值、K值、α角和MA值比较,差异均有统计学意义(P<0.05);其中,重症组R值、K值较中重症组和轻症组缩短,重症组α角、MA值大于中重症组和轻症组,差异有统计学意义(P<0.05);中重症组R值、K值较轻症组缩短,中重症组α角、MA值大于轻症组,差异有统计学意义(P<0.05)。TEG和APACHⅡ及Marshall评分系统相关性分析:APACHⅡ及Marshall评分和R值及K值呈负相关(r=-0.127,-0.238,-0.459,-0.213);和α角、MA值呈正相关(r=0.439,0.267,0.379,0.136),差异有统计学意义(P<0.05)。结论 TEG联合凝血指标可较真实地判断AP患者早期凝血纤溶状态,更准确地预测AP发病早期的严重程度,对临床救治有一定的指导意义。
