Clinical Investigations Of Anti-platelet Functions Of Ozagrel In Patients With Acute Coronary Syndrome In PCI

IntroductionACS is a series of clinical syndrome,because of the coronary artery artherosclerotic plaque rupture and platelet adherency avtivation and aggregation is the main composition of the fresh thrombus which leads to sudden lumens stenosis of steaty acute coronary,even occlusion and makes acute myocardial ischemia,injury and necrosis..Therefore,under the therapeutic principle of early PCI benefits to severe stenosis or occlusive coronary artery and is best treatment to ACS.But clinically considerable patients have simultaneously severe UGIT affection or aspirin hypersensitiveness and ban to aspirin,considerable patients react insensitively to clopidogrel plus aspirin or clopidogrel plus aspirin resistance,present standard regimen of antiplatelet therapy misfit.To further reduce thrombotic complications and stent restenosis after PCI,We attempted to add To Ozagrel further reduce thrombotic complications and stent restenosis after PCI,We attempted to add Ozagrel in addition to conventional dual antiplatelet(aspirin and clopidogrel)and evaluate the efficacy and safety of the novel triple antiplatelet regimen(aspirin and clopidogrel combined with Ozagrel)applied after PCI,and explored the effects of triple antiplatelet therapy on platelet aggregation and activation in patients who underwent coronary stenting,in order to provide experimental evidence for clinical application of the novel combination of triple antiplatelet regimen.MethodsFrom October 2006 to April 2007,a total of 60 ACS patients as a group,who in the Department of Cardiology,Xijing Hospital,Fourth Military Medical University,and 20 persons whose CAG examination is normal as the contrast group.60 in-hospital coronary heart disease patients undergoing successful coronary stenting were randomized to receive either triple antiplatelet drags of aspirin and clopidogrel combined with Ozagrel 1(groupB,triple group,20 patients)or dual antiplatelet drugs of aspirin and clopidogrel(groupA dual group,20patients)or dual antiplatelet drugs of Ozagrel and clopidogrel(groupC dual group,20patients).Since first day after stenting Ozagrel was added to triple group patients who were previously administered aspirin and clopidogrel.Expressions of CD61 and CD62p which indicate platelet activation assessed by Flow cytometry and.All patients received clopidogrel loading dosage 300mg and aspirin 300mg at leastl hours before angioplasty.Apply the method of prospective and subject contrast fore-and-aft treatment;make use of the flow cytometry determinate the CD62P,CD61 expression level in 60 patients with ACS fore-and-aft the treatment with Ozagrel.make use of the ELISA determinate the vWF GMP-140 expression level in 60 patients with ACS fore-and-aft the treatment with Ozagrel.make use of the radio-immunity determinate the TXB2 expression level in 60 patients with ACS fore-and-aft the treatment with Ozagrel.And then study that in 20 normal persons by contrast.All measurement data are expressed as mean±s.The difference of three groups and fore-and-aft treatment in the same group is expressed with the t-test.The resultsuggests:1.before treatment the CD62P,TXB₂,vWF,GMP-140 expression level in patients with ACS is obviously higher than that in normal control. There is significance difference between two groups(P＜0.05).CD61 expression level in patients with ACS is as well higher than that in normal control,but there is no significant difference between them(P＞0.05).2.CD62P,TXB₂,vWF,GMP-140 expression level in patients with ACS after the treatment(72h) with Ozagrel is lower than that before treatmen.There is significant difference between them(P＜0.05).After treatment CD61 expression level is lower than that before treatment.There is no significant difference between them(P＞0.05).3.Prospective platelet function trial:The baseline clinical characteristics did not differ significantly between the three groups.There were no significant differences in the baseline level of CD62p,TXB₂,vWF,GMP-140 and at the third day after stenting between the three groups.Among above measurements,CD62p/TXB₂/vWF GMP-140in triple group patients were significantly higher than those in dual group patients although CD61 did not significantly differ at the third day after stenting.4.At 1-month clinical follow-up,the rate of major adverse cardiac and cerebral events(MACCE) was 0 in triple group and 2.5%(1/40)in dual group,and the rate of hemorrhage was 5%(1/20) in triple group and 5.0%(2/40)in dual group,although the differences were not statistically significant.Conclusion:1.the platelet activation in patients with ACS is obviously higher than that in normal persons,and CD62P,TXB₂,vWF,GMP-140 express level up-regulation;2.Ozagrel can restraint platelet activation further in patients with ACS by restraining the function of platelet combined with the novel regimen.3.As possible mechanism for beneficial effects of triple antiplatelet,the novel regimen with aspirin and clopidogrel combined with Ozagrel is more efficient in inhibiting platelet activation and aggregation after coronary stent implantation,especially in ACS patients with high risk of thrombosis,compared with dual antiplatelet regimen with aspirin plus clopidogrel.In addition,multiple biological effects of Ozagrel possibly contribute to its extra benefits for patients received triple antiplatelet regimen.4.beneficial effects Ozagrel of is equal to aspirin or superior to aspirin,then substitutes aspirin and changes conventional dual antiplatelet regimen5.This novel triple antiplatelet regimen(aspirinand clopidogrel combined with Ozagrel)for PCI patients is safe and more efficient than dual antiplatelet therapy regimen(clopidogrel and aspirin)in reducing incidences of death and MACE at a short-term period.6.Ozagrel is more efficient in considerable patients who react insensitively to clopidogrel plus aspirin or clopidogrel plus aspirin resistance...