Key result
Acute ischemic stroke was associated with a significantly higher prevalence of clopidogrel hypo-response at 24 hours compared to other cerebrovascular diseases (79% vs 33%, aOR 10.2).
Why the study?
It remained unclear when sufficient antiplatelet effect is achieved after a clopidogrel loading dose in patients with acute ischemic stroke.
Does clopidogrel 300 mg loading dose result in different platelet reactivity in patients with acute ischemic stroke compared to other cerebrovascular diseases?
Observational (n=56)
No
Does clopidogrel 300 mg loading dose result in different platelet reactivity in patients with acute ischemic stroke compared to other cerebrovascular diseases?
Odds Ratio: 10.2 (95% CI 1.5–118.66)
Absolute Event Rate: 79% vs 33%
p-value: p=0.016
Patients with acute ischemic stroke exhibit substantially higher residual platelet reactivity at 24 hours after a 300 mg clopidogrel loading dose compared to patients with other cerebrovascular diseases, suggesting acute stress responses may attenuate early antiplatelet efficacy.
May warrant alternative agents or monitoring in acute ischemic stroke; hypothesis-generating for randomized loading-dose trials.
Objective It remains unclear when sufficient antiplatelet effect is achieved after administration of a loading dose of clopidogrel in patients with acute ischemic stroke (AIS). This study aimed to evaluate the clopidogrel response in patients with AIS identified by the platelet function test (PFT). Methods P2Y 12 reaction unit (PRU) values measured using VerifyNow at baseline and at 6, 24, and 72 h after administration of a loading dose (300 mg) of clopidogrel were compared between patients with AIS and those of other cerebrovascular diseases (CVD). The prevalence of clopidogrel abnormal response and its associated factors were examined. Results The PRU value was significantly reduced with time in the other CVD group ( p < 0.0001), and also in the AIS group ( p = 0.0073). The PRU values were significantly higher in the AIS group than in the other CVD group ( p < 0.0001 between the groups, baseline: 314 ± 53 vs. 284 ± 62, p = 0.35; 6 h: 290 ± 66 vs. 214 ± 71, p = 0.016; 24 h: 270 ± 75 vs. 190 ± 70, p < 0.0001; and 72 h: 231 ± 76 vs. 163 ± 93, p = 0.105). The prevalence of clopidogrel hypo-responder (PRU > 240 at 24 h after administration) was higher in the AIS group (79 vs. 33%, p < 0.0001) and associated with the baseline PRU value but not with the cytochrome P450 2C19 genotype or clinical ischemic events. Conclusions Residual platelet reactivity at 24 h after clopidogrel loading was substantially higher in patients with AIS than in patients with other CVD. In addition, most patients with AIS were judged to be hypo-responders on PFT. This should be carefully interpreted in patients with AIS because of poor specificity for predicting clinical ischemic events.
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Enomoto et al. (2022) conducted an observational in Acute ischemic stroke vs other cerebrovascular diseases (n=56). Acute ischemic stroke vs. Other cerebrovascular diseases was evaluated on Clopidogrel hypo-response (PRU > 240) at 24 hours after loading dose (aOR 10.2, 95% CI 1.50-118.66, p=0.016). Acute ischemic stroke was associated with a significantly higher prevalence of clopidogrel hypo-response at 24 hours compared to other cerebrovascular diseases (79% vs 33%, aOR 10.2).
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