Clinical Observation Of The Treatment Of Cerebral Infarction By The Use Aspirin And The Combined Use Of Aspirin And Clopidogrel

Objectives:Ischemic stroke was the acute or chronic occlusion or stenosis of supplying thebrain blood vessels leading to neurological function deficit, its clinical features werethat it could lead to sudden onset, progress rapidly and localized or diffusesymptomatic cerebral function defect. Its incidence, mortality and disability rateswere high, which made up the three largest cause of death in humans, it had becomethe first cause of death and disability. With the in-depth study, the accumulation ofclinical experience, both at home and abroad for the acute stage of ischemic stroketreatment had reached a basic consensus, that is, the early application of antiplateletdrugs, But it had been long time for the issue of the selection of antiplatelet agentsand the dose of antiplatelet drug, and the end the event in large study was alwaysvascular event recurrence rate. This study was to investigate the effects of differentdose of aspirin and combination for its safety and aspirin resistance phenomenon inpatients with ischemic stroke through the observation of aspirin aspirin200mg、clopidogrel75mg combined application of aspirin100mg、and aspirin100mg intreatment of cerebral infarction14days to100mg oral aspirin for3months.Methods:We Selected patients with acute cerebral infarction in the First affiliated hospitalof Ji Lin University Neurology in February2014-December2014, divided whominto100mg of aspirin group (here referred to as aspirin group1),200mg aspiringroup (here referred to as aspirin group2), the group of combination of aspirin withclopidogrel (here referred to as joint group). And evaluated three kinds of treatmentsby statisticsing NIHSS score before and after treatment for14days of three groups ofpatients, changes direction and degree of aggregation rate in three groups before and after the treatment, the adverse reactions associated with antiplatelet agents occuredduring hospitalization. Moreover, counted Modified RankinScal score after3months，so we could see whether different treatment options in acute stage effects patientsrecoved nerve function defect symptoms. At the same time, according to thedetermination of platelet aggregation rate and incidence of vascular events in patientsafter3months, we could assess aspirin resistance phenomenon.Findings:1. The comparison of NIHSS score in aspirin2and combined group before andafter the treatment had significant difference (P <0.05); Comparison between twogroups were statistically significant(P <0.05): aspirin2group and combined groupcomparison P=0.001<0.05. NIHSS score of aspirin2group decreased obviously.2. Platelet aggregation rate in aspirin2group and aspirin1group decreasedsignificantly before and after treatment (P <0.05); Comparison between two groups(P=0.010<0.05) were statistically significant. Platelet aggregation rate weresignificantly lower in aspirin2group.3. According to the reducing degree of platelet aggregation rate before andafter the treatment in the two groups, we could statistics treatment effectiveness. Theresults showed that the comparison of efficient ratio in the two groups werestatistically significant(P<0.05), and degree of platelet aggregation rate in aspirin2group reduced significantiy.4. The incidence of adverse drug reactions between the three groups during theacute phase had no diffences(P>0.05).5. After3months follow-up,when a hospital Modified RankinScal scores wereimproved significantly in the three groups, but was no significant difference betweengroups.6. After3months follow-up, the recurrence of ischemic events in the threegroups had statistically no significance (P=0.992<0.05).7. According to the platelet aggregation rate of aspirin in the aspirin1group,we could obtain a total of22cases aspirin resistance, including3cases happened ischemic event after3months follow-up, the rate of13.7%, while2cases hadincidence of ischemic events among the rest of78laboratory aspirin sensitive, the rateof2.6%, P=0.035<0.05, both had some statistical difference.8. According to platelet aggregation rate after treatment, aspirin1group had22people showing up laboratory aspirin resistance and aspirin2group had9people,accounted for22%and14%respectively, which had no statistical difference, namelythe aspirin1group and aspirin group2had no obvious difference between theprobability of laboratory aspirin resistance.Interpretation:1. In the acute phase of cerebral infarction, aspirin200mg and aspirin100mg+clopidogrel75mg can improve the symptoms of nerve function defect, butaspirin200mg group can obviously improve neurologic symptoms. And according tothe adverse reactions of the acute phase, there is no differences between them.2. The platelet aggregation rate were decreased after the treatment for14daysin the acute phase of cerebral infarction in the two groups, but aspirin2group wassignificantly lower. And according to the degree of decline, aspirin2group washigher.3. The symptoms of nerve function defect the recurrence rate of ischemicevents and between have no differences after3months follow-up.4. Aspirin resistance includes laboratory aspirin resistance determined throughthe platelet aggregation rate and clinical aspirin resistance obtained by ischemicevents, and laboratory aspirin resistance rate has something to do with clinical aspirinresistance rate.5. Aspirin dose has nothing to do with laboratory aspirin resistance, solaboratory aspirin resistance can predict clinical aspirin resistance after the treatmentof aspirin200mg.