Argatroban Platelet Function In Patients With Acute Cerebral Infarction

Background and Objective Acute cerebral ischemia is associated with the function of platelets and coagulation. Argatroban, a new direct thrombin inhibitor, has been used in acute cerebral ischemia onset in 48 hours to improve the outcome and the life quality and it is high safety in using. Argatroban has the effect on blood coagulation, but its effect on the blood platelets aggregation is still unknown and need to further study. Our study is to discuss the effect and the probably mechanism of the Argatroban on platelets aggregation in acute cerebral ischemia.Subjects and Methods Sixty acute cerebral ischemia patients were assigned into our study, 34 males and 26 females, average age was 66.86±8. 97. The patients were rolled in the study qualified for: (1) the cerebral ischemia within 6-48 hours of stroke symptom onset were enrolled, exclude the transient ischemia attack, cardiogenic cerebral embolism; (2) The patients with Eessen >2 need clopidogrel treat and exclude the bleeding or bleeding tendency or those who have serious heart,liver function disorder (AST, ALT more than normal 1～1.5 times). All patients were assigned into two groups after the patients or the family members are agreed and signed, one is the Argatroban therapy group(30 cases), another is the Clopidogrel therapy group (30 cases). The age, gender, the cerebral stroke history, complicating diseases such as: hypertension, diabetes mellitus, hyperlipoidemia, cardiac disease are comparability and no statistically significant difference between the two groups. All patients in the two groups received the basic treatment for acute cerebral ischemia. Besides the basic therapy, patients in Argatroban therapy group received continuous intravenous Argatroban at first two days (120 mg/d) by venous pump, intravenous injected Argatroban 20mg twice a day for the next 5 days, and received clopidogrel 75mg/d after Argatroban therapy. Patients in clopidogrel therapy group only received clopidogrel 75mg everyday after hospitalization continuously. To measure the platelets aggregation at baseline and the second morning, the 48th hour, the 7th day, the 14th day after therapy, and to measure platelet counts(PLA), activaty partial thromboplastin time(aPTT) before and the 14th day after therapy.Results The comparison in Argatroban therapy group: The platelets aggregation was no significantly difference between the baseline and the second day morning after Argatroban therapy(P>0.05).The platelets aggregation was significantly higher at 48th hour, 7th day than baseline in patients of Argatroban therapy group(P<0.01), while it was lower at the 14th day than baseline, the difference is significantly (p<0.01). The comparison in Clopidogrel therapy group: The platelets aggregation at the second day morning, 7th day and 14th day was lower than baseline in patients of Clopidogrel therapy group, the difference is significantly (p<0.01). The comparision between the two groups: The PA difference between the second morning, the 7th day after therapy and before therapy is significant difference between in Argtroban therapy group and clopidogrel therapy group(P<0.01).The platelets aggregation was no difference between the two groups at the 14th day after the therapy. The PLA and the aPTT were no difference between the groups before and after the therapy.Conclusion The platelets aggregation that was induced by adenosine diphosphate evaluated significantly after intravenous Argatroban in acute cerebral infarction. There were no long term effect on PLA and aPTT after Argatroban therapy.