MINISTRY OF EDUCATION MINISTRY OF NATIONAL AND TRAINING DEFENSE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES BUI THI MIEN STUDY EFFICACY OF 600MG LOADING DOSE OF CLOPIDOGREL ON PLATELET AGGREGATION AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION IN ST SEGMENT ELEVATION MYOCARDIAL INFARCTION Major: Anesthesia Resuscitation Code: 62.72.01.22 SUMMARY OF DOCTOR OF MEDICINE DISSERTATION HANOI - 2018 The work was completed at: 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES Science facilitators: Prof Dr Nguyen Quang Tuan Assoc Prof Dr Be Hong Thu Reviewers: The dissertation will be protected at the Thesis Review Board at 108 Institute of Clinical Medical and Pharmaceutical Sciences Time The dissertation can be found at: National Library of Vietnam Library of 108 Institute Pharmaceutical Sciences of Clinical Medical and BACKGROUND Several studies have evaluated the efficacy of 300mg loading dose of clopidogrel before percutaneous coronary intervention or through fibrinolytics When comparing normal dose of clopidogrel (300 mg) with doubled dose of clopidogrel (600 mg), many studies show that 600mg loading dose of clopidogrel works faster, and inhibits ST aggregation more strongly and improves effectiveness of clinically percutaneous coronary intervention In order to reduce waiting time, the 600 mg loading dose of clopidogrel inhibits TC faster and more strongly Within hours after administration of 600mg loading dose of clopidogrel, the TC is almost completely inhibited, which reduces the risk of thrombotic occlusion stenting and side effects similarly to the 300mg loading dose of clopidogrel To evaluate the efficacy of 600mg loading dose of clopidogrel before percutaneous coronary intervention in patients with ST segment elevation myocardial perfusion, the study on efficacy of 600mg loading dose of clopidogrel on platelet aggregation and outcomes of percutaneous coronary intervention in ST segment elevation myocardial infarction" was carried out for two purposes: Compare the efficacy of 600mg and 300mg loading doses of clopidogrel on platelet aggregation in ST segment elevation myocardial infarction patients with percutaneous coronary intervention Evaluate the efficacy of percutaneous coronary intervention using 600mg loading dose of clopidogrel clinically, subclinically and some undesirable effects CHAPTER OVERVIEW 1.1 ACUTE ST SEGMENT MYOCARDIAL INFARCTION ELEVATION 1.1.1 Diagnosis of ST segment elevation myocardial infarction Table 1.1 Standards for diagnosis of myocardial infarction Determination of increased cardiac markers (troponin is the most commonly used) with at least one value higher than the 99th percentile of the upper limit, with at least one of the following criteria: Symptoms of myocardial ischaemia Significant fluctuations of new ST-T or new possibility of occurrence or completely new left bundle branch block Occurrence of Q wave on ECG The most recent imaging proof of alive cardiac muscles or new occurrence of dyskinesia Determination of coronary thrombosis through angiography or autopsy 1.1.2 Treatment of ST segment elevation myocardial infarction 1.1.5.1 General initial treatment Patients should be lying motionlessly on beds If patients are over anxious, tranquilizers should be given Oxygen therapy is indicated with SaO2 0.05 3.2 COMPARING EFFICACY OF 600MG LOADING DOSE OF CLOPIDOGREL AND 300MG LOADING DOSE OF CLOPIDOGREL ON PLATELET AGGREGATION OF WITH ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION TREATED BY PERCUTANEOUS CORONARY INTERVENTION 3.2.1 Platelet aggregation before and after clopidogrel loading dose between two groups 11 Table 3.19 Electrocardiographic fluctuations after coronary intervention between the two groups Time of doing ECG Group 600mg 300mg Comments: Before intervention After intervention p before Patient s % Patient s % Elevation 46 100 2,2 Partial reduction 0 38 82,6 Back to normal 0 15,2 Elevation 50 100 16,0 Partial reduction 0 40 80,0 Back to normal 0 4,0 p of groups p> 0.05 Electrocardiographic and after