| Objective:To reduce the incidence of cardiac events in patients with coronary artery disease and then patients Quality of life,and a lower social and family financial burden,platelet inhibition rate(AA)and platelet inhibition rate(ADP)were determined by Thrombelastography(TEG),and individualized treatment was given to patients with coronary artery disease after PCIMethod:56 patients who were underwent TEG detected platelet function after accepted percutaneous coronary stent implantation(PCI)were adopted from January2016 to June 2017 in cardiovascular department of Yijishan Hospital Affiliated Wannan Medical College.The patients were divided into two groups by TEG-detected platelet inhibition rate,the platelet inhibition rate was in the normal range of patients as normal reaction group,a total of 42 cases,patients with reduced platelet inhibition rate as low response group,a total of 14 cases.If the Patients was in the normal response group,they were treated with aspirin(100 mg,qd)and clopidogrel(75 mg,qd)in combination antiplatelet therapy.Patients in the low reaction rate were given medication the antiplatelet drug.If AA-induced by arachidonic acid Of platelet inhibition rate was reduction,the aspirin chang to cilostazol 50 mg,bid,if the ADP-induced by adenosine diphosphate disodium decreased,the amount of clopidogrel added to 75 mg bid.The patients were followed up for 6-month after PCI to observation wether platelet inhibition rate wer improved and comparison of two groups of patients with recurrent ischemic events.Results:There were 37(66.07%)males and 19(33.93%)females among the 56 patients.The mean age was 64.1 ± 9.6(39-81 years old).The age,sex,age,smoking history,history of hypertension no significant difference(P> 0.05).Iinitial measured platelet inhibition ADP and 6 months after the retest platelet inhibition rate of ADP in response to the lower group was significantly lower than the normal group,the difference had statistically significant(P <0.05).Coronary heart disease in patients with dual antiplatelet therapy after PCI,TEG test found that when the platelet inhibitory rate decreased,adjusted antiplatelet therapy,recurrent ischemic events were significantly reduced,platelet inhibition rate can be improved;patients with low response group,although the proportion of diabetes than the normal response group,but by statistics The results of the decomposition showed that the difference was not statistically significant(P> 0.05).There were no significant differences in other laboratory indexes such as WBC,HGB,PT,APTT,TNR and DD(P >0.05),indicating that patients with higher platelet count were in hypercoagulable state,and the platelet inhibition rate was also lower.The response was lower in the low-response group Compared with the normal group,the number of scaffolds implanted was significantly higher(P <0.05),indicating that the more stents in patients with coronary artery disease treated with PCI,the more prone to anti-platelet Drug resistance.Conclusion:Patients,whose inhibition rate of platelet tested by Thrombelastography was decreased,with coronary heart disease treated with dual antiplatelet therapy after PCI,the inhibition rate of platelet could be improved after the adjustment of the antiplatelet therapy.The MACE,re-ischemic events and hemorrhage the incidence did not increase,so the map of thrombus elasticity has a greater clinical value.Coronary heart disease patients treated with PCI,the more number of stent implantation,the more prone to antiplatelet drug resistance.Increased platelet count is the result of hypercoagulable state Cause,eventually can lead to reduced platelet inhibition.There is a trend toward a low response to antiplatelet drugs in patients with diabetes,but further studies are needed to confirm this conclusion;patients undergoing PCI should also be actively controlled on the basis of dual antiplatelet therapy. |
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