血栓弹力图评价老年患者抗血小板治疗的临床意义

Clinical significance of thrombelastogram for the assessment of antiplatelet treatment in the elderly

目的应用血栓弹力图观察我院老年患者服用抗血小板药物后血小板抑制率的变化情况。方法选择我院门诊和住院的62例抗血小板治疗的老年患者,并将患者分成阿司匹林组、氯吡格雷组、阿司匹林+氯吡格雷组,16例未服用抗血小板药物的患者为对照组,应用血栓弹力图仪分别测得4组花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率值,并进行比较分析。结果阿司匹林组AA诱导的血小板抑制率为(78.93±11.73)%,氯吡格雷组ADP诱导的血小板抑制率为(53.4±21.5)%,阿司匹林+氯吡格雷组AA诱导和ADP诱导的血小板抑制率分别为(93.27±5.73)%和(55.8±24.6)%,血小板抑制率均显著高于对照组(P<0.01)。结论血栓弹力图能客观反映老年患者服用抗血小板药物后血小板抑制率的变化。阿司匹林能起到较好的抗血小板作用,其抗血小板作用优于氯吡格雷,同时服用阿司匹林和氯吡格雷能起到更有效的抗血小板作用。

Objective To observe the changes of platelet inhibition rate by thrombelastogram in the elderly patients receiving anti-platelet treatment. Methods Sixty-two elderly patients receiving anti-platelet treatment in our hospital were divided into 3 groups（ aspirin group,clopidogrel group and aspirin combined with clopidogrel group） according to the anticoagulants. Sixteen elderly patients who did not receive anti-platelet treatment were enrolled as control group. All patients underwent the detection of thrombelastogram. The levels of platelet inhibition rate were analyzed and compared between four groups. Results The platelet inhibition rate induced by arachidonic acid（ AA） in aspirin group was（ 78. 93± 11. 73） %,and the platelet inhibition rate induced by adenosine diphosphate（ ADP） in clopidogrel group was（ 53. 4 ±21. 5） %. The platelet inhibition rate induced by AA or ADP in aspirin combined with clopidogrel group was（ 93. 27 ±5. 73） % and（ 55. 8 ± 24. 6） %,respectively. The platelet inhibition rate in the above three groups were higher than that in control group significantly（ P〈0. 01）. Conclusions Thrombelastogram can reflect the changes of platelet inhibition rate. The effects of aspirin for antiplatelet are better than clopidogrel. Cooperation of aspirin and clopidogrel can inhibit platelet aggregation more effectively.