Application Value Of Thromboelastography And Prediction Model In First-month Hemorrhage Risk Of Ischemic Stroke Patients Treated With Double Antiplatelet Therapy

Objective Antiplatelet aggregation therapy is an effective measure for the treatment and secondary prevention of acute cerebral infarction.Reducing platelet aggregation function can effectively prevent recurrence of stroke,but at the same time increase the risk of bleeding.Thromboelastography can timely and accurately reflect the individual's coagulation state and platelet function.The purpose of this study was to explore the value of thromboelastogram parameters in predicting the risk of hemorrhage in early antithrombotic therapy in patients with acute ischemic cerebrovascular disease,and to establish an effective hemorrhage prediction modelMethod A total of 120 continuous stroke patients admitted to Wuhan Tongji Hospital from September 1,2013 to September 1,2018 were selected.The risk factors,clinical data,laboratory data,thromboelastogram results and imaging data were retrospectively analyzed.The hemorrhage was followed up within one month after the treatment with double antibodies.Logistic regression analysis was used to screen out the risk factors of hemorrhagic events in patients with ischemic stroke,and a new prediction model was established.The score threshold was obtained by drawing receiver operating characteristic curve(ROC).The high-risk group was higher than the score threshold,while the low-risk group was lower than the score threshold.Results Univariate analysis showed that there were no significant differences in age,sex,smoking,alcohol consumption,past stroke or TIA history,history of hypertensive blood glucose and lipid disease,biochemical indicators,blood routine,coagulation function analysis and glucose metabolism between the two groups(P > 0.05),but there were significant differences in creatinine value and NIHSS score(P < 0.05).Compared with the non-bleeding group,the level of MA(ADP)in the bleeding group was lower(P=0.001)and the inhibition rate of ADP was higher(P=0.003).Multivariate logistic regression showed that MA(ADP)((OR = 0.929,P = 0.004),NIHSS(OR = 1.168,P = 0.010)were independently correlated with hemorrhagic events.The area under ROC curve was used to evaluate the thromboelastographic index for hemorrhagic events: AUC 0.715(95% CI 0.598 to 0.832),P = 0.026,cutoff value = 17.65 under MA(ADP)curve;Logit P model: AUC 0.789(95% CI 0.687 to 0.890),P < 0.001,cutoff value = 0.176.Conclusion 1.The MA(ADP)of thromboelastogram parameters and NIHSS scores were significantly different between hemorrhagic group and non-hemorrhagic group,which were independent influencing factors of early hemorrhagic complications of acute cerebral infarction.2.ROC curve showed that MA(ADP)< 17.65 mm had better diagnostic value for hemorrhagic events.3.When the Logistic model score was greater than 0.176,the risk of early hemorrhage in patients with acute cerebral infarction was significantly increased.