The efficacy of antiplatelet therapies as evaluated by thrombo-elastography in retired Chinese officers.

Abstract

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. 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 clopidogrel) and no antiplatelet drug. TEG was used to evaluate the efficacy of antiplatelet therapy in the four groups. 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 antiplatelet therapy was 45.9% in the aspirin group, 51.2% in the clopidogrel group and 81.4% in the dual-drug group. A multivariate 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 (HbA1c, OR = 1.358, p = 0.011) were risk factors for thrombosis. 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 HbA1c levels may influence the efficacy of an antiplatelet therapy.