关键词: 卒中; 缺血性; 抗血小板聚集; 血栓弹力图

Abstract:

Objective To choose sensitive anti-platelet aggregation drugs in acute non cardiogenic cerebral infarction patients with thromboelastography(TEG), and evaluate the clinical results. Methods One hundred and sixty-two acute non cardiogenic cerebral infarction patients were collected in Beijing ChaoYang Hospital from Jan 2013 to Dec 2014. They were divided into individual therapy group (n =54 Aspirin 100 mg plus clopidogrel 75 mg for 14 days, then choose aspirin or clopidogrel according to the results of thromboelastography), aspirin group(n =54) andclopidogrel group(n =54). Venous blood samples were collected at day 7 after hospitalization. A TEG instrument was used to detect arachidonic acid (AA)-induced inhibition rate of platelet aggregation and adenosine diphosphate (ADP) receptor-induced inhibition rate of platelet aggregation. Experienced physicians determined baseline National Institutes of Health Stroke Scale (NIHSS) scores and Activity of Daily Living Scale (ADL) scores at the time of admission, and at day 14, day 90 respectively. Compared the baseline information and AA or ADP-induced inhibition rate of platelet aggregation, and assess the NIHSS score, ADL score at day 14 and day 90, and summary the number of recurrent ischemic stroke and cerebral hemorrhage events. Results There are no significant difference among the three groups in age, gender, hypertension, diabetes, high cholesterol, smoking, drinking, previous stroke, coronary heart disease and the admission NIHSS score and ADL score (P >0.05). The median rate of AA and ADP induced platelet pathway inhibition in the individual therapy group was 93.2%(77.45%, 98.35%), 50.4%(27.62%, 67.25%) respectively, while the AA-induced platelet pathway inhibition in aspirin group and the ADP-induced platelet pathway inhibition in clopidogrel group was 73.05% (40.8%, 92.75%), 20.5% (5.1%, 53.5%) respectively, There was statistically significant between individual therapy group and group aspirin and group clopidogrel (P <0.05). The median NIHSS score at day 14 in the individual therapy group, aspirin, clopidogrel group was 3(2, 4), 3.5(3, 4), 4(3, 4) respectively, and the median ADL score was 80(70, 90), 75(70, 85), 70(65, 85) respectively, while the median NIHSS score at day 90 was 2(2, 3), 3(2, 3), 3(2, 3) respectively, and the median ADL score was 90(85, 95), 87.5(80, 90), 85(80, 90) respectively. There are significant differences on NIHSS and ADL score between individual therapy group and aspirin or clopidogrel group at day 14 and day 90 (P <0.05); however, there was no statistic significance between aspirin and clopidogrel group(P >0.05). During three months follow up, there was no cerebral hemorrhage cases in three groups, however there was one case of recurrent ischemic events in individual group, three in the aspirin group, and four in clopidogrel group respectively. Conclusion Given aspirin and clopidogrel during the acute non-cardiogenic acute cerebral infarction, then select sensitive antiplatelet drug according to TEG can improve the prognosis of acute non cardiogenic cerebral infarction patients, and does not increase the risk of hemorrhage.

Key words: Cerebral infarction; Antiplatelet therapy; Thromboelastography