Abstract
PurposeThe 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.ResultsA 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 aggregationMethodsThis 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.ConclusionsCR 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.
Highlights
Stroke is one of the leading causes of mortality among the elderly [1], and ischemic stroke (IS) accounts for 80% of all strokes [2]
clopidogrel resistance (CR) was significantly associated with greater age (p = 0.013), diabetes mellitus (p < 0.001), and higher fasting plasma glucose levels (p < 0.001)
The results showed that diabetes mellitus, CR (HR = 2.76, 95% confidence interval (CI): 1.32–6.82, p < 0.001), and clopidogrel plus aspirin (HR = 0.67, 95% CI: 0.58–0.89, p = 0.006) were independently associated with early neurological deterioration (END) (Table 5)
Summary
Stroke is one of the leading causes of mortality among the elderly [1], and ischemic stroke (IS) accounts for 80% of all strokes [2]. Patients with an acute IS are at a high risk of developing an early neurological deterioration (END) and recurrent ischemic stroke (RIS) [3]. END occurs in 20% to 40% of patients with acute IS, and is associated with increased morbidity and mortality [3,4,5,6]. Spontaneous reversal with conservative management occurs only in one-third of these patients, a large proportion of patients who deteriorated did not recover back to predeterioration deficits [7]. It is very important to underscore the importance of prediction, and target therapies to reverse, halt, or even prevent deterioration in patients with acute IS
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