Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke

// Xingyang Yi 1 , Jing Lin 2 , Yanfen Wang 1 , Ju Zhou 1 , Qiang Zhou 2 and Chun Wang 1 1 Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China 2 Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China Correspondence to: Jing Lin, email: yixingyang64@163.com , 22350277@qq.com Keywords: ischemic stroke; clopidogrel resistance; early neurological deterioration; sroke recurrence Received: August 21, 2017      Accepted: February 28, 2018      Published: April 13, 2018 ABSTRACT Purpose: The relationship between response to clopidogrel and early neurological deterioration (END) after acute ischemic stroke (IS) is not well defined. The aim of present study was to evaluate the associations of clopidogrel resistance (CR) with END, and stratified analyze the effectiveness of clopidogrel alone and clopidogrel plus aspirin for the prevention of END. Results: A total of 375 patients, 144 patients were received clopidogrel alone, 231 patients took clopidogrel plus aspirin. CR occurred in 153 patients (40.8%). 95 (25.3%) patients developed END within the first 10 days. Platelet aggregation was higher on admission, and inhibition of platelet aggregation was significantly lower in patients with END than patients without END. Diabetes mellitus, CR, and clopidogrel plus aspirin were independently associated with END. Dual antiplatelet therapy with aspirin and clopidogrel can inhibit both arachidonic acid (AA)-induced and ADP-induced platelet aggregation Methods: This was a prospective, two-center study. A total of 375 IS patients taking clopidogrel alone or clopidogrel plus aspirin were enrolled. Platelet aggregation was measured before and after the 7–10 day treatment. CR was assessed by adenosine diphosphate (ADP)-induced platelet aggregation. The primary endpoint was END within the 10 days after admission. The secondary endpoint was a composite of recurrent ischemic stroke, myocardial infarction, and death during the 10 days after admission. Conclusions: CR and END are fairly common after acute IS. CR is associated with higher risk of END. Clopidogrel plus aspirin combination therapy provides greater inhibition of platelet aggregation, and may afford protection against END.