Journal of Hebei Medical University ›› 2022, Vol. 43 ›› Issue (5): 591-596.doi: 10.3969/j.issn.1007-3205.2022.05.019

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Study on the value of thrombus elastography combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke

  

  1. 1.Department of Blood Transfusion,Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing

    University Medical School, Jiangsu Province, Nanjing 210000, China； 2.Department of Blood Transfusion,

    the 910th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army,

    Fujian Province, Quanzhou 362000, China； 3.Department of Outpatient, Nanjing Red Cross Hospital， Jiangsu Province, Nanjing 210000, China

  • Online:2022-05-25 Published:2022-05-30

Abstract:

Objective  To explore the value of thrombus elastography(TEG) combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke.

Methods  A total of 732 patients with ischemic stroke who received clopidogrel and aspirin dual antiplatelet therapy were enrolled. Venous blood was collected at 7 d after treatment for TEG and routine coagulation index detection. The patients were followed up for 6 months, and the recurrence of ischemic stroke during the follow-up period was statistically analyzed. Clinical data were collected to analyze the relationship between TEG, coagulation function and recurrence after dual antiplatelet therapy in patients with ischemic stroke, and the value of TEG combined with coagulation function indexes in predicting recurrence.

Results  Twenty-four cases were lost to follow-up, and among the remaining 708 cases, 226 cases experienced recurrence(recurrence group)and 482 cases did not experience recurrence(non-recurrencegroup). Coagulation reaction time(R), blood clot formation time(K), international normalized ratio(INR) were shorter or lower in recurrence group than in non-recurrence group(P＜0.05), Rate of hemagglutination(α angle), maximum intensity of blood clots(MA), blood coagulation index(CI), fibrinogen(FIB), D-dimer(DD) were higher than those in non-recurrence group(P＜0.05). Logistic stepwise regression analysis showed that diabetes mellitus, high α angle, high MA value and high D-D were risk factors for recurrence in patients with ischemic stroke after dual antiplatelet therapy(P＜0.05). After adjustment for diabetes mellitus,α angle(OR=1.411，95%CI：1.006-1.987), MA(OR=1.205, 95%CI: 1.003-1.475), D-D(OR=1.198, 95%CI: 0.101-1.387) were still risk factors for recurrence after dual antiplatelet therapy in patients with ischemic stroke(P＜0.05). Receiver operating characteristic curve(ROC) results showed that the area under the ROC curve of combined α angle, MA value and D-D in predicting the recurrence of patients with ischemic stroke after dual antiplatelet therapy was 0.910, which was higher than 0.720, 0.756 and 0.760 of detection alone(P＜0.05).

Conclusion  α angle, MA value and D-D are related to recurrence after dual antiplatelet therapy in patients with ischemic stroke, and have certain predictive value for recurrence of stroke. Combined detection of the three indexes can improve the predictive efficacy.

Key words: ischemic stroke, thrombus elastography, coagulation function