| Objective:We aimed to study the effects of different antiplatelet therapy on platelet aggregation rate in patients with acute cerebral infarction and its effects on the prognosis and recurrence of cardio-cerebrovascular events, to provide individualized and the most suitable antiplatelet therapy for patients with acute cerebral infarction.Methods:The study was designed as a prospective, partial randomized, open controlled clinical trial. From January 2014 to December 2014, 144 patients with acute cerebral infarction in our hospital were chosen in this study. Patients were divided into mono asprin group(aspirin 100 mg per day), mono clopidogrel group(clopidogrel 75 mg per day) or dual antiplatelet group(aspirin 100 mg per day plus clopidogrel 75 mg per day). The above three groups were randomly divided into groups with or without ozagrel sodium injection(ozagrel sodium injection 100 ml twice per day). Platelet maximum aggregation ratio levels were measured in all patients on admission and at 7 days. Neurological function defect(national institutes of health stroke scale, NIHSS) on admission and at 7 days and self-care ability(modified Rankin Scale, m RS) at three months and one year after discharge were also recorded. The MAR levels before and after treatment between groups were compared,as well as the the short- and long-term prognosis. We also determined if there was aspirin or clopidogrel resistance, and also analyzed the correlation between MAR levels and baseline data in each group.Results:1) 144 patients were enrolled in our study, including 26 cases in aspirin group(group A), 23 cases in aspirin plus sodium ozagrel injection group(Group B), 18 cases in clopidogrel group(Group C), 13 cases in clopidogrel plus sodium ozagrel injection group(Group D), 36 cases in aspirin plus clopidogrel group(Group E) and 28 cases in aspirin, clopidogrel plus sodium ozagrel injection group(Group F).2) The LDL-c levels in group B(2.74±0.72 mmol/L) were significantly lower than in group A and F(versus group A: 3.23±0.70, p=0.031; versus group F: 3.34±0.89, p=0.009). The LDL-c levels in group D(2.62±0.78 mmol/L) were lower than in group F(versus group F: p=0.010). The CRP levels were higher in group D(18.40±22.77 mg/L) than in group C and F(versus group C: 6.90±2.16, p=0.010; versus group F: 6.82±1.60, p=0.005).3) There was no significant difference in MARAA levels on admission in each group(p=0.353). The MARAA levels at 7 days in group A, B, E and F were significantly lower than those on admission(group A: 33.55±16.57 versus 47.34±21.49, p<0.001; group B: 35.85±17.00 versus 52.73±23.91, p=0.001; group E: 26.54±8.63 versus 49.68±20.05, p<0.001; group F: 25.12±8.71 versus 51.90±25.16, p<0.001). Aspirin resistance existed in group A, B, E and F, the total resistance rate was 7/113(6.2%) without significantly difference(p=0.388). The MARAA levels on admission and MPV(r=0.179, p=0.035), fasting blood glucose(r=0.204, p=0.018) were positively correlated. The MARAA levels at 7 days had correlations with D-dimer(r=0.274, p=0.005), CHOL(r=-0.248, p=0.003) and LDL-c(r=-0.183, p=0.031).4) There was no significant difference in MARADP levels on admission in each group(p=0.375); The MARADP levels in group C, D, E and F at 7 days were significantly lower than those on admission(group C: 38.72±10.82 versus 53.79±14.20, p<0.001; group D: 41.81±18.93 versus 58.15±17.46, p<0.018; group E: 39.01±13.40 versus 62.70±12.73, p<0.001; group F: 38.01±11.24 versus 59.36±18.79, p<0.001). Clopidogrel resistance existed in group C, D, E and F, the total resistance rate was 11/95(11.6%) without significantly difference(p=0.173). The MARADP levels on admission were associated with NIHSS score differences(NIHSS score on admission minus NIHSS score at 7 days)(r=-0.201, p=0.016) and MPV(r=0.269, p=0.001). The MARADP levels at 7 days had correlations with NIHSS score on admission(r=-0.205, p=0.014) and MPV(r=0.187, p=0.028).5) There was no significant difference in NIHSS score on admission between groups(p=0.675). The NIHSS score in each group at 7 days was significantly lower than those on admission(group A: 2.35±2.12 versus 3.85±3.15, p=0.001; group B: 2.35±2.29 versus 3.61±4.01, p=0.046; group C: 3.50±3.17 versus 4.78±3.70, p=0.030;group D: 3.30±3.57 versus 4.62±4.50, p=0.044;group E: 3.16±2.57 versus 4.22±2.52, p=0.001;group F: 4.39±4.05 versus 5.11±4.07, p=0.030). No significant difference was observed in NIHSS score at 7 days(p=0.125), as well as NIHSS score differences(NIHSS score on admission minus NIHSS score at 7 days) between each group(p=0.819). There were no differences in the m RS at three months and one year after discharge, the recurrence rate of cardio-cerebrovascular events and all-cause mortality during one year after discharge between groups(p=0.735, p=0.916, p=0.210, p=0.510).Conclusions:1) Common dosage of aspirin, clopidogrel or combination of them in patients with acute cerebral infarction all had a definite antiplatelet aggregation effect.2) Dual antiplatelet therapy with aspirin and clopidogrel can inhibit platelet aggregation more comprehensive in different pathways and did not increase the bleeding risk, but there was no additive inhibition effect on the platelet aggregation pathway induced by AA or ADP.3) The MARAA levels had a further decline after adding ozagrel sodium into dual antiplatelet therapy, suggesting that triple antiplatelet therapy may be safe and more effective in inhibiting platelet aggregation.4) There were different levels of aspirin or clopidogrel resistance in our patients.5) There were no differences in the short- and long-term prognosis in each group. |
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