TEG Features And Related Factors Of Aspirin Resistant Patients With Recurrent Cerebral Infarction

Background:Cerebral infarction is a kind of disease with high incidence and high morbidity. It is reported that the prevalence of stroke in our country has increased at an annual rate of 8.1% in the past 25 years, in which cerebral infarction accounts for about 78%, ranking in the first place [1].Cerebral infarction seriously affects human health, and the recurrence rate is very high. About 4%-14% of patients relapse each year, and this number can even amount to 30% in the early phase [2]. Recurrence often indicates poor prognosis. China’s ischemic stroke and transient ischemic attack secondary prevention guidelines suggest that, patients of non-cardio-embolic ischemic stroke or transient ischemic attack (TIA) should be given anti-platelet drugs as secondary prevention, aspirin and clopidogrel are both recommended [3]. As an effective antiplatelet drug, aspirin is widely used in secondary prevention of cardiovascular events. But aspirin on platelet aggregation is not valid for all patients, because some patients still have cardiovascular or cerebrovascular events despite taking antiplatelet regularly and adequately. Since Mehta etc, described this phenomenon for the first time in 1978, more and more clinicians are paying attention to aspirin resistance. The word "aspirin resistance" began to appear in the literature since 1993 and it can be divided into clinical aspirin resistance and biochemical aspirin resistance.Objective:To evaluate the efficacy of aspirin monotherapy and aspirin plus clopidogrel dual antiplatelet on patients with recurrent cerebral infarction by use of thrombelastography, and to explore the relationship between the clinical and the biochemical aspirin resistance, as well as the clinical risk factors for clinical and biochemical aspirin resistance, so as to guide the individual antiplatelet therapy.Methods:Collect patients with cerebral infarction who were admitted to hospital within 48 hours of onset from November 2013 to January 2015. Record their basic information and relevant medical history. Setthe recurrence of cerebral infarction as the experimental group, the onset of cerebral infarction group was the control group. Patients were given continuous regular use of anti-platelet drugs longer than five days. Afterwards, detect platelet inhibition rate in the patients, requiring at least seven days away from the onset, through thrombelastography. AA inhibition rate represents the antiplatelet effect of aspirin, and ADP inhibition rate represents the antiplatelet effect of clopidogrel. Then analyze the collected data with statistical method.Results:1、The incidence of laboratory aspirin resistance in recurrent cerebral infarction is 30% and 40%,with Aspirin monotherapy and aspirin plus clopidogrel therapy respectively.2. When treated with aspirin monotherapy, the presence of aspirin resistance in patients with recurrent cerebral infarction was significantly higher than patients with first-occurred cerebral infarction, with significant difference (P<0.05);3. For those who have received aspirin and clopidogrel dual antiplatelet therapy, patients with low AA inhibition rate also show low ADP inhibition rate;there is no significant difference between recurrent cerebral infarction patients who receive dual antiplatelet therapy and those who receive aspirin in aspirin resistance rate.4. For those recurrent cerebral infarction patients, there is no significant difference between aspirin monotherapy and aspirin plus clopidogrel dual therapy in the occurrence of biochemical aspirin resistance. But in terms of compliance rate of antiplatelet therapy, dual therapy has better results.5.Patients who have recurrent cerebral infarction are more likely to show biochemical aspirin resistance p=0.029,0R=2.9206. This study shows that, biochemical aspirin resistance and high levels of homocysteine are independent risk factors for recurrence of cerebral infarction through the Logistic regression analysis,(p=0.028 and 0.006,OR=2.589and 1.101 respectively).Conclusions:1. The incidence of clinical aspirin resistance is higher than the incidence of biochemical aspirin resistance in cerebral infarction;2. When treated with aspirin monotherapy, the presence of aspirin resistance in patients with recent recurrent cerebral infarction was significantly higher than patients with first-occurred cerebral infarction;3. Dual therapy can increase the compliance rate, but there is no synergy in combination with clopidogrel on platelet inhibition rate;4. Biochemical aspirin resistance and high levels of homocysteine is independent risk factors for recurrence of cerebral infarction, which reserves more attention;5. Thrombelastograph can be used to evaluate the efficacy of antiplatelet drugs in clinical and to guide individual treatment.