Clinical Study Of Individualized Withdrawal Time Of Preoperative Clopidogrel Based On TEG

Objective: Clopidogrel is a potent antiplatelet drug that is widely used clinically.The best time to stop clopidogrel before surgery is still controversial.Current guidelines recommend stopping clopidogrel 5-7 days before surgery,but there is no conclusive evidence that this option can benefit patients undergoing non-cardiac surgery.The time window recommended by the guidelines is formed without monitoring the patient’s platelet function.In fact,we do not know whether stopping clopidogrel for 5-7 days in high-risk patients will increase the risk of thrombotic events.In this study,thrombelastography(TEG)was first used to evaluate the efficacy of clopidogrel drugs,and the inhibition rate of antiplatelet drugs was measured by TEG to evaluate the efficacy of clopidogrel drugs.Secondly,a comparative analysis of the correlation between clopidogrel withdrawal time and TEG coagulation indicators,with a view to exploring the value of TEG in guiding the optimal timing of clopidogrel withdrawal in the perioperative period,and for preoperative withdrawal of patients undergoing clopidogrel treatment.Provide individualized and precise management of medicine timeMethods: The first part retrospectively included 125 patients under general anesthesia who received stent-assisted coil embolization for the treatment of intracranial aneurysms.TEG was used to evaluate the response of different patients to clopidogrel drug treatment,and the distribution of the number of ADP values of different TEGs was counted.,Compare the TEG values and general clinical data of patients in group A(clopidogrel resistant group)and group B(clopidogrel non-resistant group).In the second part,a total of 32 non-cardiac general anesthesia patients who received clopidogrel antiplatelet therapy were selected.Before the operation,the patients who met the standard were tested for TEG coagulation and were divided into two groups according to the preoperative clopidogrel withdrawal time.Compare the general clinical data,type of operation,and conventional coagulation of patients in group C(preoperative clopidogrel withdrawal time <5 days)and group D(preoperative clopidogrel withdrawal time ≥ 5 days)between the two groups Tests,CCTs)and TEG test data,perioperative observation indicators and follow-up results.At the same time,the correlation between clopidogrel withdrawal time,TEG ADP value and intraoperative blood loss was analyzed.Results:(1)TEG was used to evaluate the efficacy of 125 patients receiving clopidogrel drug treatment.It was found that 41 patients had clopidogrel resistance(ADP<30%),and the test results showed that clopidogrel was non-resistant(ADP≥30%).There are 84 patients with clopidogrel,of which 56 patients have a normal inhibition rate of clopidogrel(70%≥ADP≥30%),and 28 patients have clopidogrel exceeding the normal inhibition rate(ADP>70%).Group A and Group B patients in K time,Angle angle,MA value,AA value,gender,age,height,weight,BMI,hemoglobin(HB),red blood cell value(RBC),platelet value(PLT),blood glucose value(Glu),activated partial thromboplastin time(APTT)and D-dimer(D-D)were not statistically significant(P>0.05),but the differences in R time,PT,INR were statistically significant(P<0.05).(2)A study of 32 patients undergoing non-cardiac general anesthesia who received clopidogrel antiplatelet therapy found that patients in groups C and D were in ASA classification,gender,age,height,weight,BMI,and accompanying diseases(hypertension,Diabetes,history of coronary stents,history of stroke),CTTs and TEG values,estimated blood loss,intraoperative blood transfusion,and operation time were compared,and there was no statistical difference(P>0.05).In the results of postoperative follow-up,there were no postoperative blood transfusions,postoperative thrombotic events,reoperation,death,myocardial infarction,and stroke events between the two groups of patients,but the difference in hospital stay between the two groups was statistically significant(P<0.05).In addition,there was no correlation between the preoperative clopidogrel withdrawal time and the intraoperative blood loss(P>0.05),and the TEG test result ADP value was significantly positively correlated with the intraoperative blood loss(correlation coefficient |r| =0.776,P<0.05).Conclusion:(1)The application of TEG to evaluate the efficacy of clopidogrel drugs found that different patients have very different responses to clopidogrel drug treatment.Compared with the clopidogrel non-resistant group,the clopidogrel resistant group had a higher coagulation status.(2)For patients undergoing non-cardiac surgery treated with clopidogrel,stopping the drug for less than 5 days before surgery may not increase the risk of perioperative bleeding.TEG-ADP may be a reliable indicator of the optimal timing of preoperative clopidogrel discontinuation,and the withdrawal time is not a reliable basis for determining the timing of preoperative clopidogrel discontinuation.