| Objective:Ischemic stroke is caused by a variety of reasons leading to the brain blood supply obstacles and then appears cerebral tissue ischemic necrosis.It is one of the most common multicausal neurology disease,with poor prognosis,high death and disability.It brings heavy burden to patients' family and society.And at present stage,one of the biggest challenges health undertakings in our country face is also ischemic stroke.Vivo platelet activation,adhesion and aggregation are closely related to the occurrence of this disease development.Antiplatelet therapy is the basic treatment in secondary prevention of ischemic stroke.Clopidogrel is a kind of command thiamethoxam pyridine class antiplatelet drugs,and its clinical application is highly safety,and it can significantly reduce the relative risk of ischemic time."Bounce" platelet is found in recent years by heart cerebrovascular patients who discontinue clopidogrel treatment.And it is lack of a clear and scientific definition.There is also no prospective trials reported platelet activity antiplatelet drug discontinuation of recoil and a direct connection between adverse ischemic events.By monitoring platelet function,this study analyzes the relations between clopidogrel and platelet function bounce,platelet function bounce and correlation of recurrence of ischemic stroke and aims to guide clinical rational drug use.Methods:Collected patients in the Harison international peace hospital between September 2014 and November 2015 who were in neurology taking clopidogrel with ischemic stroke,size of about 289.At the same time start to monitor the platet function in these patients(AA,ADP)and follow up statistics of adherence and also record the statistics of stopping taking clopidogrel patients for various reasons.Then continue for at least 2 months for platelet function testing,observation of platelet "aggregation" rebound and primary endpoint(ischemic)correlation occurred.For X2-Analysis of data using statistical software SPSS19.0,P<0.05 showed that the difference was statistically significant.Results: 1?Among 289 cases of patients,clopidogrel “resistance” or low responders of 30 patients(10.4%),then continue to follow up of these patients,transient ischemic attack recurrent TIA or ischemic stroke of about 8 cases(26.7%),not clopidogrel “resistance”or low responders 259 cases(89.6%).For various reasons(economic mission does not reach the designated position,hemorrhage,with not enough health education,etc.),stop taking clopidogrel about 153 cases,drug withdrawal rate is about 52.9%,The recurrence rate was 26.8% after drug withdrawal.(Table 1)2?Platelet rebound appears after stopping taking clopidogrel in patients with ischemic stroke.We continue to test platelet function of these patients who have stopped taking clopidogrel for at least 2 months(especially in 1 week,2 weeks and 4 weeks),platelet aggregation rate almost increased in different degrees.ADP-PL-11 displays rang from 45%-60%(Table2,Fig.2).Changes of platelet function in patients with ischemic stroke increases the risk of recurrent stroke.3?Found that about 76 patients appeared the change of the platelet aggregation function that“bounce”and there are 33 cases of ischemic stroke recurrence.Platelet funtion bounce and recurrence of ischemic stroke exist significant correlation(P<0.05)which prompted that there is a correlation between stopping taking clopidogrel,platelet function and ischemic stroke.Conclusion:After the discontinuation of clopidogrel ischemic cerebral apoplexy patients exist platelet function bounce,the changes of platelet function will increase the risk of ischemic stroke recurrence.This means that the reasonable application of antiplatelet drugs for prevention of ischemic stroke remains to be further attention,the reasonable application of clopidogrel guidance is of important clinical value. |
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