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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
AFRICA
357
The efficacy of antiplatelet therapies as evaluated by
thrombo-elastography in retired Chinese officers
Yongzeng Chen, Xi Wang, Qian Yu, Fan Wang, Haijun Wang, Hongbin Liu
Abstract
Aim:
This study evaluated, using thrombo-elastography
(TEG), the efficacy of antiplatelet therapies in retired Chinese
officers and explored the factors influencing the efficacy of
antiplatelet therapies.
Methods:
Nine hundred and fifty-five retired male Chinese
officers (
≥
60 years old), who had undergone TEG between
June and August 2015 at the Chinese People’s Liberation
Army General Hospital (PLAGH), were enrolled in this
study. The subjects were divided into four groups according to
the antiplatelet drug(s) that they were administered: aspirin,
clopidogrel, dual drugs (combination of aspirin and clopi-
dogrel) and no antiplatelet drug. TEG was used to evaluate
the efficacy of antiplatelet therapy in the four groups.
Results:
The inhibition of platelet aggregation induced by
arachidonic acid (AA%) was 48.0
±
19.3% in the aspirin
group, and the inhibition induced by adenosine diphosphate
(ADP%) was 63.0
±
18.2% in the clopidogrel group. The
AA% and ADP% in the dual-drug group were 51.0
±
16.5
and 46.0
±
15.3%, respectively. The total efficacy of anti-
platelet therapy was 45.9% in the aspirin group, 51.2% in the
clopidogrel group and 81.4% in the dual-drug group. A multi-
variate logistic regression analysis of the maximum amplitude
of ADP-induced platelet–fibrin clot strength (MA-ADP)
indicated that in the population with MA-ADP
<
31 mm,
an increased white blood cell count (OR
=
1.262,
p
<
0.001)
was a risk factor, while an increased platelet count (OR
=
0.995,
p
=
0.013) was a protective factor for bleeding. In the
population with MA-ADP
>
47 mm, increased platelet count
(OR
=
1.006,
p
<
0.001), estimated glomerular filtration rate
(eGFR, OR
=
1.016,
p
=
0.013) and glycated haemoglobin
levels (HbA
1c
, OR
=
1.358,
p
=
0.011) were risk factors for
thrombosis.
Conclusion:
This quality-controlled TEG procedure was
an efficient method to evaluate the efficacy of antiplatelet
therapies in the clinic. White blood cell and platelet counts,
and eGFR and HbA
1c
levels may influence the efficacy of an
antiplatelet therapy.
Keywords:
thrombo-elastography, aspirin, clopidogrel
Submitted 7/11/17, accepted 18/7/18
Published online 10/8/18
Cardiovasc J Afr
2018;
29
: 357–361
www.cvja.co.zaDOI: 10.5830/CVJA-2018-041
Atherosclerotic cardiovascular and cerebrovascular diseases,
including coronary heart disease (CHD) and stroke, have
become the leading causes of death in China and around
the world. Arterial thrombosis caused by the activation,
adhesion and aggregation of platelets in atherosclerotic lesions
is the pathophysiological basis of acute cardiovascular and
cerebrovascular diseases. Antiplatelet therapy is essential for the
treatment of these diseases.
1-3
Clinical research has shown that even with adequate
standardised antiplatelet treatment, such as aspirin at 100 mg/
day and/or clopidogrel at 75 mg/day, some patients with CHD
still had repeated episodes of acute coronary syndrome, and
others may develop ecchymosis or gastrointestinal bleeding.
This suggests that there may be differences in the efficacy of
antiplatelet therapy in different populations.
4,5
Evaluation of the
efficacy of antiplatelet therapy is therefore important for the
treatment and prognosis of cardiovascular and cerebrovascular
diseases.
The thrombo-elastography (TEG) method can be used to
monitor the processes of blood coagulation and fibrinolysis.
Because TEG is widely available and is easy and convenient, it
has been widely used in clinics.
6
In this study, we evaluated the
efficacy of antiplatelet therapies in retired Chinese officers, using
the TEG method, and we also explored the factors influencing
the efficacy of antiplatelet therapies.
Methods
This was a cross-sectional study and 955 retired male Chinese
officers were enrolled. The subjects voluntarily underwent
TEG during their routine examination at the Chinese People’s
Liberation Army General Hospital (PLAGH) between June and
August 2015.
We excluded subjects who had any of the following conditions
from our study: those who had received antiplatelet therapy for
less than two weeks, were treated with any kind of anticoagulant,
had severe organ dysfunction, an advanced malignant tumour,
a mental disorder and/or cognitive dysfunction, and those who
exhibited any factors that were deemed unsuitable by researchers
to take part in this study.
All subjects signed an informed consent form. The study was
approved by the ethics committee of PLAGH.
The 955 subjects were divided into four groups according
to the antiplatelet drug(s) administered: aspirin group (368),
clopidogrel group (115), dual-drug group (43), and no-drug
Department of Geriatric Cardiology, Chinese PLA General
Hospital, Beijing, China
Yongzeng Chen, MD
Xi Wang, MD
Qian Yu, MD
Fan Wang, MD
Haijun Wang, MD
Hongbin Liu, MD, PhD,
liuhbcad301@163.com