Synergistic Effects Of Aspirin On Antiplatelet Function Of Clopidogrel In Patients With Mild Cerebral Infarction

Objective: To explore the regularity of oral administration of aspirin can reduce clopidogrel resistance in patients with mild acute stroke,The relationship between the metabolic types of clopidogrel and the reduction of clopidogrel resistance by aspirin was compared.Methods: The patients with mild acute stroke who were admitted to the Department of Neurology of Beijing Yanhua Hospital from January 2018 to January 2019 were collected.The clopidogrel type(fast metabolism,intermediate metabolism,slow metabolism)was measured on admission and given aspirin 100 mg and clopidogrel 75 mg double antiplatelet therapy for 3 weeks.After 1 week of double antibody treatment,thromboelastogragh was performed to evaluate the inhibition rate of ADP.Aspirin was stopped 3 weeks later,the patients were treated with clopidogrel 75 mg alone,the inhibition rates of ADP among different clopidogrel metabolism types were compared.The patients were followed up 3 months after the treatment with clopidogrel and thrombelastogragh was performed again after one week.The inhibition rate of ADP was evaluated and the patients were followed up 3 months later.Statistical analysis was carried out with SPSS19.0 statistical software.The comparison of measurement data was carried out by rank sum test,chi-square test and Fisher's exact probability method.There was statistical significance in the comparison of measurement data with rank sum test and Fisher's exact probability method(P < 0.05).Results:1.The total NIHSS score of 80 patients with mild acute stroke was 4.6 ±0.7.According to CYP2C19 genotyping,there were 32 patients with fast metabolic type,41 patients with intermediate metabolic type and 7 patients with chronic metabolic type.2.The inhibition rate of ADP was 66.2 ±9.4% in 80 patients treated with aspirin combined with clopidogrel one week after antiplatelet therapy,and 58.2 ±7.1% in 80 patients treated with clopidogrel alone one week after treatment with clopidogrel.The former was higher than the latter,P < 0.05,and there was statistical difference.3.The inhibition rate of ADP in patients with CYP2C19 genotype was significantly higher than that in patients with non-fast metabolic type(68.6 ±3.4 VS 51.2 ±2.8,P < 0.05).4.The patients were followed up 90 days after admission and the overall NIHSS score was 2.1 ±0.5.Further analysis of the relationship between CYP2C19 genotype and NIHSS score showed that there was no difference in NIHSS score between patients with fast metabolic type and non-fast metabolic type.Conclusion:1.Among clopidogrel genotypes,the antiplatelet resistance of fast metabolic genotype was significantly higher than that of other genotypes,indicating that the detection of genotype was more helpful for individualized therapy.2.This study found that aspirin combined with clopidogrel can enhance the inhibition rate of ADP in patients with mild cerebral infarction,suggesting that aspirin has a synergistic effect on clopidogrel resistance.3.There was no significant difference in NIHSS scores between different types of stroke patients with clopidogrel CYP2C19 gene at 90 days after admission,suggesting that there was no significant correlation between clopidogrel gene type and 90-day outcome,but the sample size was relatively small,which should be further verified.