High on-clopidogrel platelet reactivity among diabetic female patients with acute ischaemic stroke

Studies suggest that diabetes-related thrombotic risk differs by sex. This raises the question of whether this sex-based disparity influences the effectiveness of antithrombotic therapy. Herein, we aimed to investigate the association between sex, diabetes mellitus, and on-clopidogrel platelet reactivity in acute ischaemic stroke patients. This cross-sectional analysis used baseline data from a single-center cohort study where we recruited 650 adults diagnosed with acute ischaemic stroke receiving a 300 mg loading dose of clopidogrel from October 2022 to April 2024. Platelet reactivity was measured using the VerifyNow P2Y12 assay. The analysis was conducted using a multivariable linear regression model with an interaction term between sex and diabetes status. The overall mean platelet reactivity unit (PRU) in our study population was 168.3 ± 61.1 and was significantly higher among diabetic patients (177 ± 60 vs. 162 ± 61, p = 0.004). In our model, neither sex nor diabetes alone were significantly associated with PRU. However, the interaction between female sex and diabetes was associated with a significant increase in PRU by 20 units (95% CI: 3.0 to 37, p = 0.021). Cumulatively, diabetic female patients exhibited a PRU increase of 27.3 units compared to non-diabetic male patients, highlighting a subgroup that may require further clinical assessment.