Efficacy And Safety Of Dual Antiplatelet Therapy Guided By Continuous Platelet Aggregation Rate Detection In Patients With Acute Coronary Syndrome

Objective:To evaluate the efficacy and safety of dual antiplatelet therapy guided by continuous platelet aggregation rate detection in patients with acute coronary syndrome.Methods:A total of 104 patients with ACS admitted to the Department of Cardiology of the Second Hospital of Hebei Medical University from October 2019 to June 2020 were randomly divided into PAR guidance group and conventional treatment group.PAR detection was performed at admission,before discharge,2 weeks,1 month,3 months and 6 months after discharge in both groups.The PAR guidance group adjusted the type and dose of P2Y12 inhibitor according to the change of PAR rate at discharge and each review compared with baseline PAR₀ at admission,while the conventional treatment group only monitored PAR,but did not adjust drugs according to PAR results.PAR₀ at admission,PARn before and after discharge,major adverse cerebral and cardiac event（MACCE）and adverse reactions after 6months were compared between the two groups.Binary Logistic regression analysis was used to investigate the related factors affecting MACCE and adverse events in ACS patients.Statistical Analysis SPSS 24.0 statistical software was used,and the P value of less than 0.05 on both sides was statistically significant.Results:A total of 104 patients were included in this studay,including 50patients in PAR guidance group and 54 patients in conventional treatment group.There were no significant difference in baseline clinical characteristics between two groups（P>0.05）.The levels of baseline PAR₀（52.16±15.42vs.52.46±22.03）and PAR₁（29.38±12.20vs.33.24±11.14）before discharge between the two groups were not statistically different（P>0.05）.In the PAR guidance group,the levels of PAR at 2 weeks（26.42±13.49vs.34.75±10.70,P=0.001）,1 month（26.57±10.01vs.33.70±10.59,P=0.001）,3months（27.19±11.26vs.35.96±11.41,P<0.01）and 6 months（27.40±8.35vs.33.84±10.73,P=0.001）were lower than the conventional treatment group,and the difference was statistically significant（P<0.05）.After 6months of follow-up,there were no significant difference in the rates of the incidence in MACCE and adverse reactions between the two groups,but the total number of events in the PAR guidance group was smaller than that in the conventional treatment group.Binary logistic regression analysis showed that whether adjusting P2Y12 inhibitors according to the change of PAR rate was not a independent risk factor for MACCE and adverse events.Conclusion:Using continuous platelet aggregation rate detection to guide the adjustment of P2Y12 inhibitors has certain guiding significance in reducing the incidence of MACCE and adverse reactions in ACS patients,and a larger sample size study is needed for further verification.