Effects of combined antiplatelet treatment on cerebral hemodynamics and platelet parameters in progressive stroke patients / 医学研究生学报

ABSTRACT

Objective The double antiplatelet therapy with aspirin and clopidogrel is widely used in the progressive stroke patients.However, this therapeutic regimen is still lack of guideline confirmation .In this study, we aimed to observe the effects of cere-bral hemodynamics and platelet parameters of combined antiplatelet treatment with aspirin and clopidogrel on progressive stroke patients . Methods This retrospective study enrolled 82 patients with progres-sive stroke within 24 hours in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from January 2014 to January 2016.All the patients were divided into two groups ( single antiplatelet group and combined antiplatelet group ) according to the antiplatelet therapy .Forty patients were included in the single antiplatelet group oral-ly took aspirin 0.1g once a day while in the combined antiplatelet group forty-two patients were included to take clopidogrel 75 mg once a day besides aspirin for 21 days and then kept aspirin only .All the patients were observed for 3 months.On the 1st and 7th day of ad-mission and 3 months after admission , the patients were examined for the terms of the grades of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI), as well as the platelet parameters including plaletet count (PLT), thrombocytocrit (PCT), mean platelet volume ( MPV) and platelet distribution width ( PDW) .The thrombelastogram was done to test the plate inhibition rate . Meanwhile , the transcranial doppler examination was done to realize the cerebral hemodynamics . Results After 7 days'and 3 months'treatment, the grades of NIHSS of combined antiplatelet group were significantly decreased versus single antiplatelet group , while BI of the combined antiplatelet group was significantly increased ( P<0.05 ) .The inhibition rate induced through adenosine diphosphate pathway was higher in the combined antiplatelet group versus the single antiplatelet group (P=0.003) on the 7th day.PLT ( P=0.006) level in the combined antiplatelet group was higher than that in the single antiplatelet group , while MPV ( P=0.023) and PDW (P=0.017) were actually lower in the combined antiplatelet group than the single antiplatelet group after 7 days'treatment.After 3 months, PDW in the combined antiplatelet group was still lower than the single antiplatelet group (P=0.041).On the 7th day, Vs (P=0.046), Vm (P=0.039) in bilateral middle cerebral artery in the combined antiplatelet group were lower than the single anti -platelet group.After 3 months, the Vs (P=0.030), PI (P=0.041) in the combined antiplatelet group was further improved versus the single antiplatelet group . Conclusion The improved effects of combined antiplatelet treatment with aspirin and clopidogrel on the clinical symptoms, cerebral hemodynamics and platelet parameters were better than single antiplatelet treatment with aspirin .