Effect Of Anti-platelet Drug Clopidogrel And Aspirin In Unstable Angina Pectoris Undergoing Percutaneous Coronary Angioplasty

Objective: Unstable angina pectoris(UAP) is a special group of coronary heart diseases(CHD). It is caused mainly by thrombosis based on coronary atherosclerosis rupture, which lead to decrease of myocardium blood flow and angina pectoris. It has been testified that platelet play an important role in the pathogenesis of UAP. The anti-platelet medicine has been proved ..to have definite theraputic effect on UAP. In present study, we aim to compare the effects of aspirin and clopidogrel on platelet in unstable angina pectoris of type A coronarylesions receving coronary stenting with type B coronary lesions,by examining the levels of plasma platelet granule membrane product-140(GMP-140), thromboxane B2(TXB2) and maximal platelet aggregation rate(MPAR).Methods: A total of 62 unstable angina pectoris patients underwent percutaneous transluminal coronary angioplasty and coronary stenting. According to ACC/AHA classification, the patients were divided into type A lesion group (group A,n=32) and type B lesions group(group B,n=30).All patients received clopidogrel loading dosage 300mg and aspirin 300mg at last 2 hours before angioplasty,and thereafter, took clopidogrel 75mg and aspirin 300mg everydayPeripheral venous blood was collected before 2 hours after taking medicine,and 6 hours,24 hours one month after angioplasty,and plasma samples were analyzed for TXB2,GMP-140,MPAR by enzyme linked immunoadsorbent assay(ELISA), and immune turbidimetry,respectively.25 health control group received coronary angiography,and no atherosclerosis were found.Result: 1) The levels of GMP-140,TXB2 and MPAR in patients with unstable angina pectoris are significantly higher than the levels in control group, patients with unstable angina pectoris have platelet activation.The levels of above indexes in group B are significantly higher than in group A. 2)In group A, at 2hours after taking medicine,the levels of GMP-140,TXB2JV1PAR are significantly lower than that before taking medicine,and no significantly difference between group A and control group; In group B, at 2 hours after taking medicine,the levels of above indexes are significantly lower than that before taking medicine,but the levels of GMP-140, TXB2 are still significantly higher than control group; 3) In group A,at 6 hours and 24 hours after angioplasty,the levels of above indexes are significantly higher than that before and 2 hours aftertaking medicine; except for MPAR at 24 hours after angioplasty; there is no significantly difference between group A and control group,neither is between at 2 hours after taking medicine and at one month after angioplasty. In group B,at 6 hours and 24 hours after angioplasty,the levels of above three indexes are significantly higher than that before and 2 hours after taking medicine;at one month after angioplasty, the levels of TXB2, GMP-140 are still significantly higher than that at 2 hours after taking medicine. 4) At 6 hours,24 hours and one month after angioplasty,the levels of above indexes in goup B are significantly higher than that in group A except for MPAR at one month after angioplasty.Conclusion: l)The patients with unstable angina pectoris have platelet activation,and it is more serious in patients with type B coronary lesions than simple coronary lesions patients. 2) A loading dosage clopidogrel 300mg can inhibit platelet activation significantly 2 hours later after taking medicine.,especially ,in patients with type A coronary lesions,inhibition is effectively.3) Angioplasty can lead to intima injury and platelet activation, and it is more serious in patients with type B coronary lesions than type A coronary lesions patients.4) Current antiplatelet therapy can effectively inhibit platelet activation in unstable angina pectoris patients with type A coronary lesions,but is not completely effective in type B coronary lesion patients.