Abstract
Background: The factors associated with clopidogrel resistance in patients with stroke recurrence receiving single or dual antiplatelet treatment (SAPT or DAPT) may differ. This study compared the high on-treatment platelet reactivities (HPRs) and the factors associated with clopidogrel resistance in recurrent ischemic stroke patients receiving clopidogrel or aspirin and clopidogrel.Methods: We enrolled and allocated 275 recurrent ischemic stroke patients to the clopidogrel and DAPT groups and compared their demographics, conventional risk factors, and P2Y12 reaction units (PRUs). Clopidogrel resistance was categorized as PRU higher than 275. We performed a multivariate logistic regression analysis to determine the factors underlying clopidogrel resistance during SAPT and DAPT.Results: In total, 145 (52.7%) and 130 (47.3%) patients received clopidogrel and DAPT, respectively at recurrence. The risk factors of the two groups were not significantly different, except that coronary artery disease was more frequent in the DAPT group. The PRU was higher (255 ± 91 vs. 221 ± 84; p = 0.002) and clopidogrel resistance was more frequent (45.5 vs. 31.5%; p = 0.018) in the SAPT than in the DAPT group. Hyperlipidemia was associated with clopidogrel resistance during SAPT, and smoking (Odds ratio = 0.426, 95% confidence interval 0.210–0.861; p = 0.018) had a protective effect against clopidogrel resistance. For those receiving DAPT, old age, female, low hemoglobin A1c level, and high ARU were associated with clopidogrel resistance.Conclusions: HPR and clopidogrel resistance were more frequent in recurrent ischemic stroke patients receiving clopidogrel than in those receiving DAPT. Smoking was independently associated with less clopidogrel resistance among those receiving clopidogrel SAPT but not in those receiving DAPT.
Highlights
Antiplatelet treatment is one of the most important treatments for reducing non-cardioembolic ischemic stroke
DAPT is used for a short period after ischemic stroke, whereas for [1] those with concomitant coronary artery disease (CAD), [2] severe intra or extracranial cerebral artery stenosis, or [3] recurrent cardiovascular event under single antiplatelet treatment (SAPT), DAPT was considered for a longer-duration
Smoking was independently associated with low P2Y12 reaction unit (PRU) and less clopidogrel resistance in recurrent ischemic stroke patients receiving clopidogrel SAPT, but not in those receiving DAPT
Summary
Antiplatelet treatment is one of the most important treatments for reducing non-cardioembolic ischemic stroke. One of the major risk factors for ischemic stroke [2], enhances the activity of the P450 system [3], which increases the efficacy of clopidogrel (smoker’s paradox) [4, 5]. A post-hoc analysis of the CHANCE (Clopidogrel in High-Risk Patients with Acute NonDisabling Cerebrovascular Events) trial revealed the interaction between smoking status and the contribution of clopidogrel to the early recurrence of ischemic stroke [6]. The incidence of stroke was lower in currently smoking than in non-smoking patients receiving treatment with aspirin and clopidogrel (dual antiplatelet treatment; DAPT). The factors associated with clopidogrel resistance in patients with stroke recurrence receiving single or dual antiplatelet treatment (SAPT or DAPT) may differ. This study compared the high on-treatment platelet reactivities (HPRs) and the factors associated with clopidogrel resistance in recurrent ischemic stroke patients receiving clopidogrel or aspirin and clopidogrel
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