Thrombelastogram Combined With Platelet Aggregation Rate Test Was Used To Evaluate The Efficacy And Safety Of Antiplatelet Therapy In Patients With Coronary Slow Flow

Objective:Thrombelastogram combined with platelet aggregation rate test was used to evaluate the efficacy and safety of antiplatelet therapy in patients with coronary slow flow.Methods:Gather 50 patients in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University and was admitted because of chest tightness,chest pain,confirmed as coronary slow flow Phenomenon by coronary angiography from January 2018 to December 2018.The patients were randomly divided into two groups according to the random number table method,They were single antiplatele group and dual-antiplatelet group.The single antiplatele group was treated with 100mg Qd of aspirin tablets,while the dual-antiplatelet group was treated with 100mg Qd of aspirin tablets combined with clopidogrel sulfate tablets at 75mg Qd.While basic diseases and other risk factors were controlled,the two groups were given Statins(rosuvastatin calcium tablets:10mg Qn or atorvastatin calcium tablets:20mg Qn)and trimetazidine hydrochloride tablets 20mg Tid at the same time.The total course of treatment is 3 months.R value and MA value of thrombelastogram,platelet aggregation rate,Blood routine HGB?RBC?PLT,coagulation function PT?APTT?INR,Chest pain symptoms?frequency and duration;Electrocardiogram st-t changes;Changes of blood lipid and homocysteine.were observed and followed up before and after treatment.Patients in each group were followed up for 3 months using Patients with coronary slow flow were followed up by WeChat group to observe the occurrence of ischemic events and bleeding events,and the results were statistically analyzed.Results:1.There were no significant differences in HGB?RBC?PLT?PT,APTT and INR between the single antiplatele group and the dual-antiplatelet group before and after treatment,and all P values were>0.05.2.There was no significant difference in R and MA between the two groups before treatment,and all P values were>0.05.After treatment,the R value of the two groups increased(P<0.05)and the MA value decreased(P<0.05).Compared between the two groups,there was no statistical significance in the change of R value between the two groups(P>0.05),but the decrease of MA value in the dual,antiplatelet group was greater than that in the single antiplatelet group,and the difference was statistically significant(P<0.05).3.Before treatment,there was no significant difference in the maximum AA aggregation rate and the maximum ADP aggregation rate between the two groups(P>0.05).After treatment,the maximum AA and ADP aggregation rates in both groups were lower than those before treatment(P<0.05).Compared between the two groups,there was no statistically significant change in the maximum aggregation rate of ADP in the two groups(P>0.05),but the decrease in the maximum aggregation rate of AA in the dual-antiplatelet group was greater than that in the single antiplatelet group,and the difference was statistically significant(P<0.05).4.The comparison between the two groups showed that the significant efficiency of the single antiplatelet group was 80%and that of the dual-antiplatelet group was 84%(2=-1.039,P=0.299),and the difference was not statistically significant(P>0.05).The frequency and duration of chest pain attacks before and after treatment were statistically significant between the two groups(t=3.415,P=0.035;t=2.513,P=0.037),improved after treatment in the dual-antiplatelet group,and the difference was statistically significant(t=4.863,P=0.002;t=4.863,P=0.002).Compared with the single antiplatelet group,the frequency and duration of chest pain episodes in the dual-antiplatelet group were significantly improved(t=-3.251,P=0.041;t=2.736,P=0.037).The effective rate of 24-hour dynamic electrocardiogram ST-T change was 60%in the single antiplatelet group and 76%in the dual-antiplatelet group.The therapeutic effect of the dual-antiplatelet group was better than that of the single antiplatelet group(t=2.759,P=0.041).There were significant differences in TC,LDL-C and HCY before and after treatment in the single antiplatelet group(P<0.05).TC,LDL-C and HCY were significantly lower after 3 months than at admission.There was no significant difference in TG and HDL-C before and after treatment,P<0.05,as shown in table 2.TC,TG,HDL-C and HCY in the dual-antiplatelet group decreased significantly after treatment,all P<0.05.HDL-C had no significant difference before and after treatment,P>0.05.5.There were 5 cases of ischemic events and 3 cases of bleeding events in the 25 patients in the single antiplatelet group,4 cases of ischemic events and 5 cases of bleeding events in the 25 patients in the dual-antiplatelet group.After statistical analysis of ischemic events ?2=-1.143,P=0.285,statistical analysis of bleeding events ?2=0.862,P=0.353.The differences were not statistically significant.6.Ischemic events were taken as positive events,and the normal coagulation function PT,APTT,INR,thrombelastogram R,MA,AA maximum aggregation rate,ADP maximum aggregation rate were analyzed by ROC curve.The R,MA,the maximum aggregation rate of AA,and the area P under the curve of the maximum aggregation rate of ADP were all<0.05,indicating that the R value,MA value,the maximum aggregation rate of AA,and the maximum aggregation rate of ADP had high specificity and sensitivity of ischemic events.7.When the bleeding event was positive,the ROC curve was used to analyze the general coagulation function PT,APTT,INR,thrombelastogram R,MA,AA maximum aggregation rate,ADP maximum aggregation rate.The area P under the curves of PT,R,MA and AA maximum aggregation rate were all<0.05,indicating that the R,MA and AA maximum aggregation rate of PT,thrombelastogram had high specificity and sensitivity of bleeding events.Conclusions:1.Both aspirin single antiplatelet therapy and aspirin combined with clopidogrel dual-antiplatelet in the treatment of patients with coronary slow flow can effectively improve platelet function,reduce the rate of platelet aggregation and improve the symptoms of chest pain onset,reduce the frequency and duration of chest pain onset,and reduce the 24-hour dynamic electrocardiogram ST-T changes.At the same time,the combination of statins and trimetazidine hydrochloride can effectively improve vascular endothelial function,reduce blood lipid level and reduce the formation of atherosclerosis.In addition,the effect of aspirin combined with clopidogrel was better than that of aspirin single antiplatelet.2.There was no significant difference in the risk of ischemia and bleeding between the patients treated with the dual-antiplatelet and those treated with the single antiplatelet,When patients with coronary slow flow are treated with short-term antiplatelet drugs for 3 months3.Thrombologram and platelet aggregation rate test have higher specificity and sensitivity in ischemic events and bleeding events than coagulation function test.