Evaluation Of Antiplatelet Effect In Patients With Acute Coronary Syndrome By Thrombelastography

Background:Acute coronary syndrome is based on coronary atherosclerosis,atherosclerotic plaque rupture or erosion,ulceration,resulting in platelet activation and thrombosis.The clinical manifestations include episodes of chest pain and chest tightness,which increase the incidence of arrhythmia,heart failure and sudden death,affecting the health and life of patients.Currently,aspirin combined with a P2Y₁₂2 receptor inhibitor is mainly used as antiplatelet standardization therapy for ACS patients.But due to the lack of effective evaluation methods,some patients are difficult to achieve the expected therapeutic effect.Objective:To evaluate the antiplatelet efficacy of ticagrelor or clopidogrel in the patients with acute coronary syndrome received different dual antiplatelet drug by using thrombelastography for detecting platelet inhibition rate.Methods:A total of 100 patients with acute coronary syndrome who were admitted to the hospital for percutaneous coronary intervention were selected from June 2017 to August 2017.According to the random oral dual-antiplatelet drugs at the time of admission,50 cases were divided into the clopidogrel group as the control group and50 cases as the observation group in the ticagrelor group.The control group was treated with aspirin and clopidogrel as the antiplatelet therapy,the observation group was treated with aspirin plus ticagrelor,and both groups were treated for 7 days.After the treatment,the antiplatelet effect was evaluated.Response time（R）,clot formation time（K）,angle（α?）,maximum amplitude（MA）,and coagulation index（CI）during the treatment of the two groups were performed using thromboelastography apparatus.The activated partial thromboplastin time（APTT）,prothrombin time（PT）and fibrinogen（FIB）level were measured before and after treatment in the two groups using a CA7000 automatic blood coagulation analyzer;Enzyme-linked mmunosorbent assay（Elisa）was used to determine the levels of High-sensitivity C-reactive protein（hs-CRP）and Interleukin-6（IL-6）before and after treatment in the two groups.Record and count the rate of platelet inhibition induced by ADP after 7-days treatment,and the bleeding rate in digestive tract,brain,urinary system,eyes,nose,gums,skin and mucous membranes,and compare the clinical efficacy of the two groups.Results:1.The R and K levels in the observation group after 7 days of ticagrelor were higher than those in the control group（P<0.05）;the levels ofα?,the MA,and CI in the observation group after 7 days were lower than in the control group（P<0.05）;2.The PT and APTT levels of the observation group and the control group after 7-days treatment were higher than that before the treatment（P<0.05）;The FIB of the observation group and the control group after 7-days treatment was lower than that before the treatment（P<0.05）;The PT and APTT levels were higher in the observation group than that in the control group after 7-days treatment（P<0.05）;The FIB was lower in the observation group than that in the control group after 7-days treatment（P<0.05）;3.There was no significant difference in the levels of hs-CRP and IL-6 before the treatment（P>0.05）.The levels of the hs-CRP and IL-6 in the observation group and control group were lower than that before the treatment（P<0.05）.There was no significant difference in the levels of hs-CRP and IL-6 after the treatment（P>0.05）.4.The platelet inhibition rate of the observation group was higher than that of the control group after 7-days treatment（P<0.05）.5.One case gum bleeding occurred in the control group,and one case gum bleeding and one case hemorrhinia occurred in the observation group.The incidence of bleeding between the control group and the observation group was no statistically significant difference（P=0.558>0.05）.Conclusions:1.Ticagrelor is superior to clopidogrel in anti-platelet aggregation by using thromboelastography to evaluate the effect in Patients with Acute Coronary Syndrome,and does not increase the risk of bleeding events.2.Ticagrelor and Clopidogrel can reduce the level of inflammatory factors in ACS patients,there was no significant difference between them.3.Thromboelastography can be used to evaluate the antiplatelet efficacy in the patients with acute coronary syndrome,which has certain clinical significance.