Correlation Between Platelet Parameters, Hypersensitive C-reactive Protein And Clopidogrel Reactivity In Unstable Angina Patients

Objectives: Unstable angina is a severe type of coronary heartdisease(CHD). Dual antiplatelet therapy with aspirin and clopidogrel wasestablished as a cornerstone of therapy in patients with unstable angina(UA)and stent implantation. Platelet inhibition by clopidogrel varies from oneindividual to the next. We refer those treated with clopidogrel had minimal orno alternation in platelet function as clopidogrel resistance(CR) or highon-treatment platelet reactivity(HTPR). CR is considered a failure ofantiplatelet treamtent. Patients who have CR are at increrased risk of majoradverse cardiac events. Recent studies have identified numerous influencingfactors for the antiplatelet effect of clopidogrel. The aim of this study was toexplore the association between platelet parameters, hs-CRP and clopidogrelresistance.Methods: A total of124unstable angena patients were enrolled in thisstudy from November2013to January2014, in the second hospital of HebeiMedical University. All patients had not taken aspirin or clopidogrel that affectplatelet function. Blood routine test, coagulation routine test, myocardialenzyme, hepatic function, renal function, plasma lipid, platelet aggregationrate(PAR0) were checked within one day. A loading dose of300mg clopidogreland300mg aspirin were given to all the patients, and75mg/d clopidogrel and100mg/d aspirin were maintained. Platelet aggregation rate was remeasured at7thday(PAR1). According to the degree of platelet aggregation inhibition[DPAI,DPAI=(PAR0-PAR1)/PAR0], all patients were devided into clopidogrelresistance group(CR) and clopidogrel sensitive group(CS). There were33cases(19males and14females) in CR group, the mean age was61.91, whilethere were91cases(49males and42females) in CS group, and the mean age was62.40.Platelet parameters including platelet count(PLT), mean plateletvolume(MPV), platelet distribution width(PDW) and hypersensitiveC-reactive protein(hs-CRP) levels were compared between the two groups. Allthe data were analyzed with SPSS16.0software. P<0.05was consideredstatistically significant.Results:1Baseline clinical characteristics: There was no significant differencebetween CR group and CS group in age, gender, BMI, history ofhypertension, history of diabetes mellitus, smoking history and drinkinghistory.2Platelet parameters and hs-CRP level: The PLT, PDW, PCT levels had nosignificant difference between the CR group and the CS group. The MPVlevel was significant higher in the CR group than that of CSgroup(9.31±1.00fl vs.8.48±0.96fl, P<0.05). And the hs-CRP level wassignificant higher in the CR group than that of CS group(6.62±4.30vs.3.38±3.18, P<0.05).3Correlation analysis: Univariable logistic regression analysis showed thatMPV and hs-CRP were independent predictors of clopidogrel resistance inunstable angina pectoris patients.Conclusions: MPV and hs-CRP were independent predictors ofclopidogrel resistance in patients with unstable angina.