Risk factors for dopidoel resistance in patients with ischemic stroke： a prospective case series study

Abstract

Objective To investigate the risk factors for clopidogrel resistance （CR） in patients with ischemic stroke. Methods Turbidimetry was used to measure the platelet aggregation rate changes after the patients with acute ischemic stroke taking 75 mg of clopidogrel per day for 10-14 days. The patients were divided into either a CR or a clopidogrel sensitivity （CS） group according to the platelet aggregation rate changes. The demographic and clinical data of both groups were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for CR. Results A total of 147 patients with acute ischemic stroke were included, 42 of them （28. 57% ） were in the RC group and 105 （71.43%） were in the CS group. The proportion of patients in diabetes （54. 76% vs. 11.43% ;x^2 = 31.054, P = 0. 000, the history of transient ischemic attack （TIA） （80. 95% vs. 26. 67% ;X^2 =36. 251, P =0. 000 or percutaneous coronary intervention （PCI） （26. 19% vs. 3.81%;X^2 = 16. 400, P=0. 000, taking calcium channel blocker （CCB） （83.33% vs. 54. 29% ;X^2 = 10. 810, P =0. 001, angiotensin converting enzyme inhibitor （ACEI）/angioteusin receptor blocker （ARB） （66. 67% vs. 42. 86% ; X^2 = 6. 803, P = 0. 009, and proton pump inhi＇bitor （47. 62% vs. 14. 29% ; X2 = 18. 375, P = 0. 000 in the CR group, as well as the levels of plasma total cholesterol （TC）, glucose, and glycated hemoglobin were significantly higher than those in the CS group. Multivariate logistic regression analysis showed that diabetes （odds ratio [ OR] 13. 711, 95% confidence interval [ CI] 1. 667- 112. 784; P = 0. 015）, increased TC level （OR 2. 828, 95% CI 1. 574 - 5. 080; P = 0. 001）, previous history of TIA （OR 16. 627, 95% CI 4. 691 - 58. 934; P =0. 000）, and bag-term taking CCB （OR 4. 147, 95% CI 1.053 - 16. 332; P =0. 042）, and ACEUARB （OR 4. 841, 95% CI 1.539 - 15. 231; P =0. 007） were the indepeadent risk factors for CR. Condmlom CR in patients with ischemic stroke is associated with a variety of factors, in which diabetes, increased TC, as well as long-term taking CCB and ACEUARB are the independent risk factors for CR. Key words: Drug Resistance; Platelet Aggregation Inhibitors; Clopidogrel; Stroke; Brain Ischemia; Risk Factors