The Correlation Research Of Diabetes Mellitus To Coagulation Function And Aspirin Resistance In The Perioperative Period Of OPCABG

Objective: This study was designed to investigate the changes of coagulation function between diabetic and non-diabetic patients during OPCABG perioperative by Thrombelastography(TEG),analysis the changes of each parameter value of the two groups,and explore the influence of OPCABG on coagulation function ahd the effects of diabetes on coagulation function in patients after OPCABG surgery.By comparing the incidence rate of AA inhibition rate and aspirin resistance(AR)between the two groups,we evaluated the effects of diabetes on AR after OPCABG,so as to provides guidance value for reasonable antiplatelet therapy on patients with coronary heart disease(CHD)complicating diabetes mellitus in the perioperative period of OPCABG.Methods:The patients with CHD who would accept OPCABG treatment for the first time in our hospital from December 2015 to January 2017 were selected.Patients who met the inclusion criteria and exclusion criteria were divided into 2 groups in accordance with the diagnostic criteria of type 2 diabetes mellitus by WHO: diabetes group(DM group)and non-diabetic group(NDM group).All of the two groups patients after admission took aspirin(l00mg/d)and clopidogrel(75mg/d)orally for more than five days before OPCABG and two days after OPCABG continued.Venous blood of the two groups were collected up and tested by TEG at different time points: T0(5 days after aspirin and clopidogrel therapy before OPCABG),T1(returning to care unit after OPCABG),T2(5 days after aspirin and clopidogrel therapy after OPCABG).The indexes of R value,K value,alpha angle,MA value,LY30 were observed and analyzed.The changes of coagulant function parameters were compared between the DM group and NDM group in the perioperative period of OPCABG,in order to explore influence of OPCABG on coagulation function and the effects of diabetes on coagulation function after OPCABG.Venous blood of the two groups was collected up and tested by TEG for platelet detection at time T0.Patients without Aspirin resistance(AA>50%)were tested again by TEG for platelet detection at time T2.The incidence of postoperative AA inhibition rate and AR between the DM group and NDM group were compared,and whether diabetes mellitus was associated with AR was discussed.Results:1 56 patients were included in this study,DM group: 30 cases,male 19 cases.NDM group: 26 cases,male 17 cases.There were no deaths,no early postoperative thrombotic events and abnormal bleeding in the two groups after OPCABG.The differences of primary clinical data of the two groups had no statistical significance(P > 0.05).2 Intra-group comparison: DM group: compared with T0,R value and K value decreased,alpha angle and MA value increased at T1 and T2,the differences were statistically significant.Significant statistics difference was found in multiple comparison at T0,T1 and T2(P<0.05).NDMgroup: compared with T0,R value and K value decreased,alpha angle and MA value increased at T1 and T2,the differences were statistically significant.Significant statistics difference was found in multiple comparison at T0,T1 and T2(P<0.05).The change rules of parameters in the two groups: R value dropped at T1 time point,and then rised at T2 time point which was still less than that at T0 time point.After OPCABG,K value decreased gradually,MA value and alpha angle increased gradually.In DM group LY30 were 0 at each time point.In NDM group there was no statistical difference in LY30 at each time point(F=0.227,P =0.797).Comparison between groups: T1: R values was lower in DM group than that in NDM group,and the difference was statistically significant(t=3.611,P =0.001).The differences of MA value,K value and alpha angle had no statistical significance(P>0.05).T0 and T2: there were no statistically significant difference in R value,MA value,K value,alpha angle and LY30 between the DM group and NDM group(P>0.05).3 Patients with normal aspirin reaction(AA>50%)by TEG for platelet detection at time T0 were selected,NDM group 21 cases,DM group 27 cases.The AA inhibition rate of DM group was significantly lower than that of the NDM group at T2 time point(t=3.277,P=0.002).The AA inhibition rate of DM group at T2 time point was significantly lower than that at T0 time point,and the difference was statistically significant(t=5.216,P=0.000).The AA inhibition rate of NDM group at T2 time point was lower than that at T0 time point,but there was no statistically significant difference(t=1.016,P=0.322).In DM group,12 cases with AR.In NDM group,3 cases with AR.It was suggested that AR was existent at the early stage after OPCABG,and the incidence of AR was higher in DM group than that in NDM group(χ~2=5.001,P=0.025).Conclusions:1 The coagulation function of patients is at hypercoagulable state at the early stage after OPCABG2 The coagulation function is affected by diabetes mellitus at the day of OPCABG.Patients with coronary heart disease(CHD)complicating diabetes mellitus have higher coagulation than those with pure coronary heart disease.But but there was no statistically significant difference at 5 days after aspirin and clopidogrel therapy after OPCABG.3 The platelet aggregation inhibition rate(AA inhibition rate)was significantly reduced in patients with CHD and diabetes mellitus after OPCABG,who have lower AA inhibition rate and higher incidence of AR compared to coronary heart disease(CHD)patients.4 TEG could reflect the state of blood coagulation function in vivo timely and accurately,and coule provide comprehensive information of coagulation and fibrinolytic function,which is helpful for screening patients at high risk of thrombotic events,evaluating the efficacy and safety of antiplatelet therapy and guiding for clinical individual therapy.