Effects Of Clopidogrel On The Platelet Activator Combined-1 In Patients With Acute Coronary Syndrom Undergoing Therapy

Objectives:Acute coronary syndrome(ACS),which includes unstable angina (UAP),ST—segment elevation myocardial infarction(STEMI),non—ST—Segment elevation myoCardial infarction(NSTEMI),is a special group of coronary heart diseases (CHD).It is caused mainly by thrombosis based on coronary atherosclerosis rupture.It has been testified that platelet and fibrinolytic system play an improtant role in the pathogenesis of ACS.The anti- platelet medicine and thrombolysitic treatments have been proved to have definite theraputic effect on ACS.Now,according to the data of pharmacodynamics and pharmacokinetics,the availability of a new antiplatelet agent clopidogrel,with a proven efficacy in the prevention of cardiovascular events,suggests the opportunity of reviewing the mechanisms of instability and the therapeutic strategies in patients with ACS.It onsets more quickly and is more powerful but with fewer side effects.So it is recommended in the cure strategy of ACS,In this preasent study,we aim to compare the effectiveness of dirrerent dosage and administration ways on the platelet function(PAC-1)and fibrinolytic system(PAI-1,T-PA)of patients with ACS.Methods:From June 2006to December 2006;60patients with ACS are enrolled in this study.All patients are given the drugs of regular and are divided into 3 groups depending on the dosage and administration Way as fo llowed:①UAP uoutine dosage group(n=15): patients received clopidogrel 75mg·d—1 continuously and were phlebotomized 3 days later②UAP Aspirin group(n=15):patients received the basic drug of aspirin only as the way described initially,and were phlebotomize 3 days later respectively③AMI combination group (n=30):patients received clopidogrel 300mg bolus plus low—molecular—Weight heparin 6150 and were phlebotomize 2 hours later④health control group(n=30):no medicine are administrated.Plasma PAC-1,PAI-1,T—PA content were measured at pre treatment and post—treatment.Results:①In ACS at pre—treatment,the level of PAC-1,PAI-1,T-PA are higher than that of health control group(P＜0.01),and the changes of these markers are more significantly in AMI patients than UAP patients(P＜0.05);②After the therapy,in the clopidogrel routine dosage group and aspirin group,PAC-1,PAI-1 are lower than that of b lank control group(P＜0.05)and T—PA is highter(P＜0.05);③After the therapy,in routine dosage group and aspirin group,PAC-1,PAI-1 are lower than pre—treatment(P＜0.05)and T—PA is highter(P＜0.05);④After the therapy,in AMI combination group,PAC-1,PAI-1 are lower than pre—treatment(P＜0.05)and T—PA is highter(P＜0.05);⑤In ACS at post—treatment,the changes of these markers are more significantly than control group(P＜0.05).Conclusions:①ACS patients have platelet activation and fibrinolytic system function repression,and it is more serious in AMI patients than UAP patients,PAC-1 is the one of sensitive markers representing the severity of coronary heart diseases②T-PA/PAI-1 are the one of sensitive markers of fibrinolytic system in ACS.③The long—time use of routine dosage clopidogrel may improve the activity of fibrinolytic system of ACS patients.