The Relationship Of Platelet Inhibition Rate With Clopidogrel Carboxylic Acid Metabolite Concentrations And Prognosis Of Elderly Patients With Acute Coronary Syndrome

Objective:To investigate the relationship of adenosine diphosphate pathway(ADP) receptor inhibition rate with clopidogrel carboxylic concentrations in acute coronary syndrome(ACS) patients treatment by clopidogrel antiplatelet therapy over 1 week, which provide observable indicators for antiplatelet therapy and more data for individual treatment in the clinic.Methods:83 patients with acute coronary syndrome, average age was70.6±11.9, from January 2013 to February 2014 were collected. All patients were collected vein blood after taking clopidogrel 3 hours, which clopidogrel antiplatelet therapy over 1 week. According to the Thrombelastograph, ADP inhibition rate>70% were clopidorel remarkable efficacy group, ADP inhibition rate<70% were poor responsiveness group. These patients were also performed by high performance liquid chromatographyultraviolet method, which was applied for dertermining the plasm concenteation level of clopidogrel metabolites. Follow up of patients prognosis, record occurrence of ischemic events(recurrent angina myocardial infarction, ischemic stroke) and hemorrhagic events.Results:1.83 acute coronary syndrome patients were included into this study, with 61 m ales and 22 females. There were 44 patients(37 males and 7 females) who presented wit h a satisfactory response to clopidogrel,and 39 patients(24 males and 15 females) whohad a poor response, the difference was significant. There was no significant difference between the two grou ps in BMI, high blood pressure, blood lipid metabolic abnormalities, diabetes, kidney d ysfunction, etc.2. By high performance liquid chromatography with ultraviolet method detection in patients with clopidogrel carboxylic acid metabolites concentration, the results showed plasma concentration of clopidogrel carboxylic acid in clopidorel remarkable efficacy group is 2.03±1.16g/ml, while the low response to clopidogrel group is2.69±1.41?g/ml, the differences between the two groups have statistical significance(P<0.05).3. Followed-up patients one year, found that clopidorel remarkable efficacy group has good low incidence of adverse cardiovascular events than the low response to clopidogrel group, especially on the incidence of recurrence of angina,the difference between the two groups have statistical significance(P<0.05). The incidence of bleeding is similar in these two groups, there was no statistically significant difference in the two groups.4. The study established a high performance liquid chromatography with ultraviolet method determination of clopidogrel carboxylic acid metabolites in human plasma concentrations. This method is specific, good stability, accuracy, and sample processing is simple, stable results.Conclusion: Acute coronary syndrome patients take the effect of the same dose of clopidogrel after may be different, clopidogrel metabolite concentrations with clopidogrel platelet aggregation level has certain relevance, clopidogrel resistance or reflect poor has increased the incidence of clinical cardiovascular events.