The Clinical Study Of The Changes Of Platelet P-selection And Von Willebrand Factor And After Clopidogrel Therapy In Elderly Patients With Acute Coronay Syndrome

Objective: Acute coronary syndrome ( ACS ) , which includes unstable angina (UAP), ST-segment elevation myocardia infarction ( STEMI) , non-ST-Segment elevation myocardia infarction ( NSTEMI ) , is a special group of coronary heart diseases ( CHD ) . It is caused mainly by thrombosis based on coronary atherosclerosis rupture . The anti- platelet medicine has been proved to have definite theraputic effect on ACS . To investigate the changes of platelet P-selection and von willebrand factor (vWF ) before and after clopidorel in elderly patients with acute coronary syndrome.Methods: The expression of activated P-selection on platelet and the plasma level of vwf were analyzed by flow cytometry or enayme linked immunosorbent assay (ELISA)in 60 elderly patients with ACS(30 acute myocardial infarction and 30 unstable angina pectoris) and 30 healthy controls. Unstable angina pectoris patients were randomly into two groups: 15 patients received clopidorel (75mg/d) plus aspirin (clopidorel group)and 15 patients received only aspirin (routine therapy group); Acute myocardial infarction patients all received combined therapy: clopidogrel (300mg) plus aspirin.Moreover,The correlation between P-selection and vWF.was also analyzed.Result:1. P-selectin and vWF levels in elderly ACS patients were significantly higher than in healthy control group (both P< 0.001).2. P-selectin and vWF were decreased in both clopidorel group and routine therapy group in UAP patients with a more significant decrease inclopidogrel group (P<0.05).3. Combined therapy quickly inhibited P-selectin and vWF in AMI patients (P<0.001).4.There was a positive correlation between the P-selectin and the vWF level (r=0.365,P=0.004).Conclution:1. The elderly acute coronary syndrome patients have platelet activation and endodermis system functional disorder.2. The P-selection and the vWF were related to the pathogenesis of acute coronary syndrome, which may be a redictor of unstable plaque of acute coronary syndrome.3. Clopidogrel may improve prognosis in elderly ACS by inhibiting platelet activation and protecting endothelium.