Evaluation of the efficacy of anti-platelet aggregation drugs in patients using thromboelastograph after percutaneous transluminal angioplasty and stenting

Objective To detect the platelet inhibition of aspirin and clopidogrel in patients after percutaneous transluminal angioplasty and stenting(PTAS) using a thromboelastograph(TEG) instrument in order to guide the individualized adjustment of anti-platelet aggregation drugs after PTAS.Methods The clinical data of 65 patients with ischemic stroke or transient ischemic attack included from Nanjing Stroke Registry Program were analyzed retrospectively.Venous blood samples were collected at day 3 after PTAS.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.The AA pathway and ADP receptor-induced inhibition rate of platelet aggregation,as well as the response differences of the patients between aspirin and clopidogrel therapy were compared.Results ①The inhibition rate(80±28%) of aspirin for the AA pathway was significantly higher than that(53±31%) of clopidogrel for the ADP receptor pathway(P0.01).②Of the 65 patients,the therapeutic effects in 45(69.2%),8(12.3%),7(10.8%) and 5(7.7%) patients were good,effective,low response,and ineffective in the aspirin group,and those in 19(29.2%),14(21.5%),23(35.4%) and 9(13.8%) were good,effective,low response,and ineffective in the clopidogrel group.Of those who had a good response to aspirin,3 had no response to clopidogrel and 14 had low response to clopidogrel;of those who had a good response to clopidogrel,all responded well or effective to aspirin.Of those who had low response to clopidogrel,4 had low response to aspirin,5 had a good response to aspirin,and 14 had good results.The two efficacies had some relevance(χ2=33.311,P0.01).③A total of 53 patients had a good+effective response to aspirin,and 12 had low response+ineffective to aspirin,while 33 and 32 patients had good+effective and low response+ineffective to clopidogrel.There was significant difference in efficacy between the two drugs(χ2m=15.042,P0.01).Conclusion Using TEG instrument to detect the inhibition rate of platelet aggregation in patients after PTAS is beneficial to guide the development of therapeutic scheme for individualized anti-platelet aggregation in clinical practice.The inhibitory effect of platelet aggregation of aspirin after PTAS is stronger than that of clopidogrel.The patients show differential responses to aspirin and clopidogrel therapy.Some patients who have low response to clopidogrel may respond well or may be effective to aspirin.