| Objective:To study the clinical value of thromboelastography in guiding the selection of antiplatelet aggregation drugs in ischemic stroke patients,improve drug efficacy and reduce related adverse reactions.Methods: A total of 150 patients with ischemic strokes from the First Hospital neurological department of Zibo City were enrolled from August 2014 to August 2016.The patients were divided into individualized treatment groups(selection of aspirin or clopidogrel after the end of the acute phase according to TEG results)in 50 ischemic stroke patients(group A),50 ischemic stroke patients in the aspirin group(group B)and 50 ischemic stroke patients in the clopidogrel group(Group C)according to the random number table method.At the same time,50 who were admitted to the hospital due to other diseases with normal coagulation function were selected as the subject group(group D).The TEG measurements and the NIHSS scores and the ADL scores were performed at admission,the7 th day,the 21 st day,and the 90 th.The baseline data and platelet aggregation inhibition rates were compared between the three groups,and the NIHSS scores,the ADL scores,and number of new on going strokes,stroke-related deaths,and drug-related cerebral hemorrhages were assessed at the 7th day,the 21 st day,and the 90 th.The data were collected to analyze the association between platelet aggregation inhibition rate and the selection of antiplatelet aggregation drugs.Results: There were no statistically significant differences in baseline data between the three groups A,B,and C.At admission,the R value and K value of the ischemic stroke patients in group A,B and C were significantly lower than those in subject group D,the difference was statistically significant(P<0.05);and the α value,MA value and CI value were significantly higher than those in subject group D,the difference was statistically significant(P<0.05).One-way analysis of variance of TEG parameters among the patient groups A,B,and C showed that there were no significant differences in TEG parameters between the three patient groups(P>0.05).On the 7th day of treatment,compared with the time of admission,the R value and K value of the patient groups A,B and C were significantly prolonged,the difference wasstatistically significant(P<0.05);and the α value,MA value and CI value were significantly shortened,the difference was statistically significant(P<0.05).There were no significant differences in the R value,K value,α value,MA value and CI value between the two time points in subject group D(P>0.05).On the 7th day of treatment,the 50 patients in group A after taking aspirin,12 patients(24.00%)had platelet aggregation inhibition rate ≤50%,and38 patients(76.00%)were >50%.Based on this result,in a further treatment,the 12 patients with platelet aggregation inhibition rate ≤ 50% were changed from aspirin to clopidogrel treatment.On the 21 st day of treatment,the R value and K value of the ischemic stroke patients in group A,B and C were significantly lower than those in subject group D,the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly higher than those in subject group D,the difference was statistically significant(P<0.05).One-way analysis of variance of TEG parameters among patients in groups A,B and C showed that the R value and K value of the patient group A were significantly higher than those of the patient groups B and C,and the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly lower than those of patient groups B and C,the difference was statistically significant(P<0.05).On the 21 st day of treatment,compared with the 7th day of treatment,the R value and K value of the patients in group A,B and C were significantly prolonged,the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly shortened.,the difference was statistically significant(P<0.05).On the 21 st day of treatment,the platelet aggregation inhibition rate of AA pathway in the patient group A was significantly higher than that in the patient group B,and the difference was statistically significant(P<0.05).On the 21 st day of treatment,the platelet aggregation inhibition rate of ADP pathway in patient group A was significantly higher than that in the patient group C,and the difference was statistically significant(P<0.05).On the 90 th day of treatment,the R value and K value of the ischemic stroke patients in group A,B and C were significantly lower than those in subject group D,the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly higher than those in subject group D,the difference was statistically significant(P<0.05).One-way analysis of variance of TEG parameters among patients in groups A,B and C showed that the R value and K value of the patient group A were significantly higher than those of the patient groups B and C,the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly lower than those of patient groups Band C,the difference was statistically significant(P<0.05).On the 90 th day of treatment,compared with the 21 st day of treatment,the R value and K value of the patients in group A,B and C were significantly prolonged,the difference was statistically significant(P<0.05),and the α value,MA value and CI value were significantly shortened.,the difference was statistically significant(P<0.05).On the 90 th day of treatment,the platelet aggregation inhibition rate of AA pathway in the patient group A was significantly higher than that in the patient group B,and the difference was statistically significant(P<0.05).On the 90 th day of treatment,the platelet aggregation inhibition rate of ADP pathway in patient group A was significantly higher than that in the patient group C,and the difference was statistically significant(P<0.05).The incidence rate of adverse events during the treatment of patients in groups A,B and C was counted,the total incidence rate of adverse events in the patient group A was significantly lower than that in the patient groups B and C,and the difference was statistically significant(P<0.05).During the treatment,the NIHSS scores of patients in groups A,B and C decreased with the prolongation of treatment time,and the difference was statistically significant(P<0.05).The amplitude of decreasing of the NIHSS score in the patient group A was significantly higher than that in the patient groups B and C,and the difference was statistically significant(P<0.05).During the treatment,the ADL scores of patients in group A,B and C increased with the prolongation of treatment time,and the difference was statistically significant(P<0.05).The amplitude of increasing of the ADL score of patients in group A was significantly higher than that in group B and C,and the difference was statistically significant(P<0.05).Conclusion: Platelet aggregation plays a role in the occurrence and progress of ischemic stroke.The antiplatelet aggregation drugs can effectively reduce the recurrence rate,mortality or morbidity rate of ischemic stroke patients at the end of follow-up.Aaspirin and clopidogrel are clinical popular used anti-platelet aggregation drugs,but the presence of different reactivity of drugs reduces the effect of drug and increases the occurrence of adverse events.Precisely anti-platelet aggregation therapy is the future research direction of anti-platelet aggregation therapy.The patients with reactive abnormalities of aspirin and clopidogrel were found by TEG in time,and provide medication guidance.The medication guidance can significantly improve the anti-platelet aggregation therapy effect,reduce the incidence of related adverse events,and play a role in guiding the selection of drugs for precisely anti-platelet aggregation therapy. |
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