Clinical Study On The Effect Of Different Antiplatelet Drug Combinations On Platelet Activity In Patients Undergoing Percutaneous Coronary Intervention

Objective:Application of thrombelastography(TEG)to detect platelet activity in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI)to guide the personalized adjustment and assessment of clinical antiplatelet drugs treatment effect.Methods:A total of 248 inpatients undergoing PCI for coronary artery disease were included in the routine grouping according to the principle of voluntary choice of antiplatelet drugs.Among them,aspirin + clopidogrel group 100 cases(AB group,n=100),aspirin+ticagrelor group 100 cases(AT group,n=100).Patients with gastrointestinal bleeding after PCI were divided into clopidogrel group 48 patients(BB group,n = 48).The TEG parameters,coagulation parameters,the incidence of hypercoagulability patterns and high platelet activity were compared among the three groups of patients,and the incidence of adverse events was followed up for 6 months.According to the platelet aggregation ability of TEG results,248 patients were divided into high platelet activity group(n=85)and normal group(n=163).The TEG parameters,coagulation parameters,and myocardial markers were compared between the two groups,and incidence of major adverse cardiovascular events(MACE)at 6months follow-up.Results:(1)The maximal amplitude(MA)values of the TEG curves of the three groups of patients were compared,aspirin+clopidogrel group> aspirin+ticagrelor group>clopidogrel group,the difference was statistically significant(P <0.05).(2)Compared with the coagulation parameters of the three groups,the D-dimer in aspirin plus clopidogrel group was significantly higher than that in clopidogrel group> aspirin + ticagrelor group(P<0.05).(3)The angle between the tangent and the horizontal line of the curve bifurcation point and the maximum radians(Angle),MA value and comprehensivecoagulation index(CI)of TEG parameters in patients with high platelet activity were significantly higher than those in the normal group,and the clot formation time(K)values were significantly lower(P<0.05).In the normal group,the blood platelet(PLT)count and fibrinogen(FIB)were significantly lower than the high platelet activity group,and the difference was statistically significant(P<0.05).(4)Incidence of hypercoagulability pattern,aspirin + clopidogrel group 16(16.0%)cases> clopidogrel group 3(6.3%)cases> aspirin + ticagrelor group 5(5.0%),the difference was statistically significant(P = 0.021).(5)There was a certain incidence of high platelet activity in the three groups of PCI patients who used different antiplatelet drug combinations.The highest incidence rate was 45(45%)cases in the aspirin plus clopidogrel group,followed by 14(29.2%)cases in the clopidogrel group,and the lowest incidence was 26(26%)cases in the aspirin plus ticagrelor group,the difference was statistically significant(P = 0.013).(6)The upper limit of the upper limit of CK-MB and LDH in patients with high platelet activity was significantly higher than that in the normal group(P<0.05).(7)After 6 months of follow-up,the incidence of adverse cardiovascular events,the high platelet activity group> aspirin + clopidogrel group> clopidogrel group>aspirin + ticagrelor group> normal group,and the difference was statistically significant(P = 0.001).5 patients with dyspnea were found in the aspirin + ticagrelor group,one of whom had severe paroxysmal dyspnea,and dyspnea after clopidogrel replacement disappeared,the other two groups did not have dyspnea.The incidence of bleeding in the three groups was not statistically significant(P>0.05).Conclusion:(1)There is still a certain incidence of high platelet activity after PCI in patients treated with different antiplatelet drugs.(2)High platelet activity may be closely related to hypercoagulability,both of which increase the incidence of ischemic events.The evaluation of platelet activity has important reference value for the personal adjustment of clinical antiplatelet drugs.(3)For patients with gastrointestinal bleeding after PCI,the clopidogrel group did not increase the risk of bleeding and ischemic events,with a certain degree ofsafety and efficacy reliability.