血栓弹力图指导颅内动脉瘤患者介入围术期抗血小板治疗

Thromboelastography guides perioperative antiplatelet therapy in patients with intracranial aneurysm

目的探讨支架辅助栓塞颅内动脉瘤患者围术期应用血栓弹力图协助指导双重抗血小板治疗的效果。方法回顾性分析156例行支架辅助栓塞颅内动脉瘤患者的临床资料,根据患者双重抗血小板用药情况分为氯吡格雷组(n=106)、替格瑞洛组(n=38)和药物调整组(n=12)。记录患者脑缺血事件发生情况,分析3组患者血栓弹力图检测结果,包括花生四烯酸(AA)抑制率、二磷酸腺苷(ADP)抑制率、ADP通道血凝块最大强度(MA-ADP),评估患者双重抗血小板治疗效果。结果156例患者住院期间发生脑缺血事件4例,发生率为2.56%。与氯吡格雷组比较,替格瑞洛组患者的ADP抑制率明显升高,MA-ADP显著降低,差异均有统计学意义(P<0.05);氯吡格雷组与替格瑞洛组AA抑制率比较差异无统计学意义(P>0.05)。药物调整组患者改服替格瑞洛后的ADP抑制率较服用氯吡格雷时显著升高,MA-ADP明显降低,差异均有统计学意义(P<0.05)。结论血栓弹力图可用于监测支架辅助栓塞颅内动脉瘤患者的血小板功能,并可在围术期对患者双重抗血小板治疗方案进行有效指导,对预防术后缺血事件的发生具有重要意义。

Objective To explore the effect of perioperative application of thromboelastography in guiding dual antiplatelet therapy for patients with stent-assisted embolization of intracranial aneurysms.Methods The clinical data of 156 patients underwent stent-assisted embolization of intracranial aneurysms were retrospectively analyzed,and the patients were divided into the clopidogrel group(n=106),the ticagrelor group(n=38)and the drug adjustment group(n=12)according to their dual antiplatelet medication status.The occurrence of cerebral ischemic events of patients was recorded,and the thromboelastography results of the three groups were analyzed,including the arachidonic acid(AA)inhibition rate,the adenosine diphosphate(ADP)inhibition rate,and the maximum intensity of ADP channel clot(MA-ADP),and the effect of dual antiplatelet therapy of patients was evaluated.Results There were 4 cases of cerebral ischemia events during hospitalization among 156 patients,and the incidence rate was 2.56%.Compared with the clopidogrel group,the ADP inhibition rate of the ticagrelor group was significantly increased,and the MA-ADP was significantly decreased,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the AA inhibition rate between the clopidogrel group and the ticagrelor group(P>0.05).The ADP inhibition rate of the patients in the drug adjustment group who switched to ticagrelor was significantly higher than that when taking clopidogrel,and the MA-ADP was significantly decreased,and the differences were statistically significant(P<0.05).Conclusion Thromboelastography can be used to monitor the platelet function of patients with stent-assisted embolization of intracranial aneurysms,and can effectively guide dual antiplatelet therapy shceme for patients during the perioperative period,which is of great significance in preventing the occurrence of postoperative ischemic events.