Effect Of Clopidogrel On Platelet Activation Function In Non ST Segment Elevation Acute Coronary Syndrome Patients

Objective Comparatively observed the changes between taking different maintenancedoses of clopidogrel before and after on the levels of serum sCD40L and CD62p, and also onthe phosphorylation levels of serum VASP in patients with non ST segment elevation acutecoronary Syndrome (NST-ACS).Methods Selected67cases non ST segment elevation acute coronary syndrome(NST-ACS) patients in general hospital of Ningxia Medical University Department ofcardiology hospital from2013January to2013July, the same time, selected28cases patientswho examined by coronary angiography or cardiac64slice spiral CT and confirmed nocoronary artery lesions as normal control group. NST-ACS patients were given300mgloading dose of clopidogrel, then randomly divided into two groups, and respectivelysequential given different maintenance doses of clopidogrel for75mg/d and150mg/d; normalcontrol group without drug intervention. Took blood samples5ml from elbow venous fordetecting the serum level of sCD40L、CD62p and phosphorylation of VASP before takingclopidogrel、taking300mg loading dose of clopidoprel after24hours and5th day. All bloodsamples separated serums in time, then frozen and stored at-70℃. The serum levelsofsCD40L，CD62p and the phosphorylation of VASP measured by ELISA，and compared thechanges before and after.Result (1) The level of serum sCD40L in group with NST-ACS patients wassignificantly higher than that in normal control group’s （612.61±126.90VS782.16±254.59）(P <0.05). In NST-ACS patients the levels of serum sCD40L before taking clopidogrel washigher than that taking300mg loading does of clopidogrel after24h’s（804.5±257.26VS700.8±217.24，860.73±154.86VS719.88±270.55）, and also higher than sequential routine dose of clopidogrel fifth days’s（804.5±257.26VS679.0±166.78，860.73±154.86VS684.23±154.23）(P <0.05), but there was no significant effect between sequential75mg/d andsequential150mg/d on the level of serum sCD40L after taking clopidogrel fifth days（679.0±166.78VS684.23±154.23）(P＞0.05).（2）The level of serum CD62p in group with NST-ACS patients was significantly higherthan that in normal control group’s（5.84±1.53VS11.96±4.15）(P <0.05). In NST-ACSpatients the levels of serum CD62p before taking clopidogrel was higher than that taking300mg loading does of clopidogrel after24h’s（12.02±3.68VS9.99±3.37，11.91±4.63VS9.81±3.36）, and also higher than sequential routine dose of clopidogrel fifth days’s（12.02±3.68VS9.85±2.96，11.91±4.63VS9.87±3.09）(P <0.05), but there was nosignificant effect between sequential75mg/d and sequential150mg/d on the level of serumCD62p after taking clopidogrel fifth days （9.85±2.96VS9.87±3.09）(P＞0.05).（3）The level of serum VASP phosphorylation in group with NST-ACS patients wassignificantly lower than that in normal control group’s （525.09±125.06VS296.86±147.41）(P <0.05). In NST-ACS patients the levels of serum VASP phosphorylation before takingclopidogrel was lower than that taking300mg loading does of clopidogrel after24h’s（307.95±135.57VS443.77±187.97，285.76±159.72VS403.90±211.66）, and also lowerthan sequential routine dose of clopidogrel fifth days’s （307.95±135.57VS394.37±213.57，285.76±159.72VS376.10±190.57）(P <0.05), but there was no significant effect betweensequential75mg/d and sequential150mg/d on the level of serum VASP phosphorylation aftertaking clopidogrel fifth days（394.37±213.57VS376.10±190.57）(P＞0.05).（4）All patients completed the trial, and there were no severe bleeding and platelet，neutrophil decrease.Conclusion (1)In NST-ACS patients, the levels of serum sCD40L and CD62p weresignificantly higher than those in normal control group, while the level of VASPphosphorylation was lower than that of normal control group.(2)The patients with non STsegment elevation acute coronary syndrome taking300mg loading dose of clopidogrel canproduce obvious inhibition function on platelet activation in24hours.（3）The patients withnon ST segment elevation acute coronary syndrome taking loading dose of clopidogrel and then sequential75mg/d or150mg/d can also inhibit the activation of platelet function.