Effect And Safety Of Anti-platelet Drug Of Different Dose Clopidogrel In Patients With Acute Coronary Symptom

Objective Acute Coronary Syndromes is caused by thrombosis based on coronary instability plaque rupture which induced platelet activation, and then lead coronary lumens more stenosis or total obstruction which show unstable angina, non-ST evelation myocardial infarction and ST elevation myocardial infarction clinically, so the anti-platelet therapy is one of the most clinical measures in treating patients with acute coronary symptom. In present study,we aim to investigate degree of inhibiting platelet activation in acute coronary symptom with aspirin and different dosage clopidogrel at different time by examining the levels of plasma maximal platelet aggregation rate(MPAR) and sP-selectin concentration, and then research the effect of association anti-platelet therapy, for clinical medicine treatment, especially for anti-platelet medicine teatment before precutaneous coronary intervention to provide information.Method A total of 48 patients with acute coronary syndromes were divided into group A(n=22) which received aspirin 100mg everyday and clopidogrel loading dosage 300mg, and thereafter, took clpidogrel 75mg everyday; and group B(n=26) which received aspirin 100mg everyday and clopidogrel loading dosage 600mg, and thereafter, took clpidogrel 75mg everyday. Peripheral venous blood was collected before, 2 hours after taking clopidigrel, 4 hours after taking clopidigrel, 24 hours after taking clopidigrel, and plasma sample were analyzed for maximal platelet aggregation rate(MPAR) by immune turbidimetry and sP-selectin concentration by enzyme linked immunoadsorbent assay(ELISA). And the adverse effects which related to clopidigrel, for example haemorrhage, thrombocytopenic purpura(TTP) and hypolekocytosis and so on, were observed in one week.Result 1. In group A: the levels of MPAR and SP-selection concentration 2 hours after taking clopidigrel are significantly lower than before(P<0.05), the levels of MPAR and SP-selection concentration 4 hours after taking clopidigrel are lower than 2 hours after taking clopidigrel(P<0.05), the levels of MPAR and SP-selection concentration 24 hours after taking clopidigrel are lower than 4 hours after taking clopidigrel(P<0.05).2. In group B: the levels of MPAR and SP-selection concentration 2 hours after taking clopidigrel are significantly lower than before(P<0.05), the levels of MPAR and sP-selection concentration 4 hours after taking clopidigrel are lower than 2 hours after taking clopidigrel(P<0.05), the levels of MPAR and SP-selection concentration 24 hours after taking clopidigrel are lower than 4 hours after taking clopidigrel(P<0.05).3. The levels of MPAR and SP-selection concentration before are no significantly difference between group A and group B(P>0.05). The levels of MPAR and SP-selection concentration 2 hours after taking clopidigrel in group B are significantly lower than group A(P<0.05). The levels of MPAR and SP-selection concentration 4 hours after taking clopidigrel in group B are significantly lower than group A(P<0.05). The levels of MPAR and SP-selection concentration 24 hours after taking clopidigrel are no significantly difference between group A and group B(P>0.05).4. One patient with gingiva bleeding appears in group A, two patients with gingiva bleeding and one patient with skin bleeding point appear in group B. No other adverse effects,for example intracranial hemorrhage, alimentary tract hemorrhage, IIP and hypolekocytosis and so on, appear in both groups.Conclusion 1. A loading dosage clopidogrel both 300mg and 600mg can inhibit platelet activation significantly 2 hours later after taking medicine in patients with acute coronary syndromes, moreover, 4 hours later after taking medicine more significantly than 2 hours later after taking medicine, 24 hours later after taking medicine more significantly than 4 hours later after taking medicine.2. The loading dosage clopidogrel 600mg can inhibit platelet activation more significantly than the loading dosage clopidogrel 300mg 2 hours and 4 hours later after taking medicine in patients with acute coronary syndromes, but there is no difference between a loading dosage clopidogrel 300 mg and a loading dosage clopidogrel 600 mg 24 hours later after taking medicine.3. Compared to a loading dosage clopidogrel 300 mg,the risk of light bleeding increases slightly in the patients with acute coronary symptom who received a loading dosage clopidogrel 600 mg.4. When the patients with acute coronary syndromes accept emergency PCI, a loading dosage clopidogrel 600mg can inhibit activation sufficiently more quickly,moreover can shorten cardiac muscle cell ischemic time ,reduce the events rate, besides is safe and tolerated.