纤维蛋白原影响冠心病严重程度与氯吡格雷治疗后残余血小板活性的相关性

Objective To explore the platelet function during clopidogrel and aspirin therapy in different presentation of coronary artery disease (CAD) and its interaction with coagulation factors. Methods This retrospective observation selected CAD subjects treated by percutaneous coronary intervention.The severity of the subjects was characterized by their clinical manifestation and numbers of coronary arteries that narrowed ＞50%.Fibrinogen and other laboratory markers were tested at admission.At least 24 hours after 300 mg dose clopidogrel loading,ADP pathway platelet inhibition ratio (PIclo) and ADP-induced maximum amplitude of clot strength (MAadp) were measured by thrombelastography.MAadp represented residual platelet reactivity. Results Totally 955 subjects enrolled.PIclo were insignificant among patients of different severities.Either more severe CAD type or heavier atherosclerosis burden group had greater MAadp (both P<0.001) and fibrinogen (both P<0.001).Fibrinogen was the leading independent correlation factor for MAadp by correaltion analysis (r=0.271,P<0.001) and linear multivariate resression.Type of CAD (r=0.174,P＜0.001) and number of narrowed coronary artery (r=0.113,P＜0.001) positively correlated to MAadp respectively.Only in the highest quartile of Fbg did both CAD type and atherosclerosis burden show positive significant to MAadp.Setting the fibrinogen a covariate changed the significant correlation between severity of CAD and MAadp. Conclusions Despite the similar PIclo,fibrinogen and residual platelet reactivity are greater in more severe presentation and atherosclerosis burden of CAD.Fibrinogen significantly affect the relationship between severity of CAD and residual platelet reactivity after clopidogre treatment.