Standard dual antiplatelet therapy was laboratory ineffective for acetylsalicylic acid in 24% of patients, clopidogrel in 27%, and both in 19% during the early phase after ischemic stroke.
Observational (n=62)
Does routine laboratory testing identify ineffective antiplatelet therapy in the early phase of secondary prevention after ischemic stroke?
A significant proportion of ischemic stroke patients exhibit laboratory resistance to standard dual antiplatelet therapy in the acute phase, suggesting a potential role for routine efficacy testing.
Abstract Background and aims Dual antiplatelet therapy is recommended for a limited period (1–3 months) due to the high risk of cardiovascular events early after non-cardioembolic ischemic stroke.The first days are the most risky, and the risk gradually decreases with time. The aim of the study was to verify the effectiveness of the therapy in a laboratory setting with standard administration. Methods The study included patients after iCMP for whom antiplatelet therapy was indicated in secondary prevention. After a loading dose of 300 mg acetylsalicylic acid and 300mg clopidogrel (+another 3 days of administration of 100 mg acetylsalicylic acid and 75 mg clopidogrel daily), laboratory efficacy was determined by the Multiplate method. In case of ineffectiveness, control testing was performed with an interval of 12 days. Results The study included 62 consecutive patients. Acetylsalicylic acid therapy was not laboratory effective in 15 patients (24%) and clopidogrel therapy in 17 patients (27%). Ineffectiveness of both drugs occurred simultaneously in 12 cases (19%). During the follow-up test, efficacy was demonstrated in 7 patients (11%) in the case of acetylsalicylic acid and clopidogrel. The test was ineffective in 3 patients in the case of both drugs (5%). Some patients did not arrive for the follow-up test without an excuse. Conclusions The results of the study indicate that a significant proportion of patients in the first, most risky days after an ischemic event do not have effective secondary prevention even with standard antiplatelet therapy. The question is whether these patients should not be routinely identified and their therapy escalated. Conflict of interest Cernik David: nothing to disclose, Neradova Jarmila: nothing to disclose
Neradová et al. (Fri,) conducted a observational in Ischemic stroke (n=62). Acetylsalicylic acid and clopidogrel was evaluated on Laboratory efficacy of antiplatelet therapy determined by the Multiplate method. Standard dual antiplatelet therapy was laboratory ineffective for acetylsalicylic acid in 24% of patients, clopidogrel in 27%, and both in 19% during the early phase after ischemic stroke.