Review on clopidogrel reactivity by thrombelastogram and flow cytometry in patients with coronary heart disease after percutaneous coronary intervention

Guo Xiaoling; Shi Yangcheng; Shao Xuesong

doi:10.3969/j.issn.1674-4055.2017.12.18

Abstract：Objective To review the diagnostic value of thrombelastogram (TEG) to clopidogrel clopidogrel, taken flow cytometry (FCM) as a reference, in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).Methods CHD patients (n=75) undergone PCI were chosen from the Huai'an Hospital of Huai'an City in Jiangsu Province from Jan. 2014 to Jan. 2016, and given aspirin and clopidogrel for anti-platelet treatment. After PCI for 7 d, the expressions of platelet membrane glycoprotein fibrinogen receptor-1 (PAC-1) and cluster of differentiation 62 platelet (CD62P) were detected by using FCM, inhibition rate of adenosine diphosphate (ADP) were detected by using TEG, and clopidogrel reactivity was recorded and analyzed. Meanwhile the patients were followed up for 1 y, the incidence of ischemia and bleeding events were recorded in patients with different clopidogrel reactivities.Results The results of FCM showed that there were 21 cases (28.0％) with high expression of platelet activation (poor clopidogrel reactivity), 36 (48.0％) with medium expression (ordinary clopidogrel reactivity) and 18 (24.0％) with low expression (good clopidogrel reactivity). The results of TEG showed that when ADP inhibition rate<38.9％, clopidogrel reactivity was poor (95％CI: 0.952～0.982) and area under ROC was 0.943 (P<0.05). According to ADP inhibition rate<38.9％, there were 22 cases with poor clopidogrel reactivity, so ADP inhibition rate had higher degree of fitting with expressions of PAC-1 and CD62P. During the follow-up period, the incidence of ischemia events was lower in patients with good clopidogrel reactivity than that in those with ordinary or poor clopidogrel reactivity (P<0.05).Conclusion ADP inhibition rate<38.9％ indicates poor clopidogrel reactivity and higher degree of fitting with expressions of PAC-1 and CD62P detected by FCM in CHD patients after PCI, which presents patients have clopidogrel resistance and can provide new thinking to guide individual treatment.