Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response

TY - JOUR

T1 - Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response

AU - Rath, Charlotte Lützhøft

AU - Jørgensen, Niklas Rye

AU - Wienecke, Troels

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND: Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS.METHODS: We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period.RESULTS: A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis.CONCLUSIONS: Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients.

AB - BACKGROUND: Antiplatelet therapy is a cornerstone prevention strategy for secondary ischemic stroke (IS) and transient ischemic attack (TIA). Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. A recent meta-analysis found an increased risk of recurrent stroke in clopidogrel- or aspirin-treated patients with ischemic stroke who had high on-treatment platelet reactivity (HTPR). Few studies have focused specifically on clopidogrel HTPR. Therefore, the aim of this study was to examine the relationship between clopidogrel HTPR and recurrent ischemic events in a population of Danish patients with IS.METHODS: We performed a prospective observational study to evaluate the relationship between HTPR defined as platelet reaction units >208 and a composite primary endpoint of recurrent stroke, TIA, acute myocardial infarction (AMI), or vascular death over a 2-year follow-up period.RESULTS: A total of 142 patients were included in the final statistical analysis, but only 3 patients (2.1%) demonstrated clopidogrel HTPR. The median time of on-treatment platelet testing was 75 days. Recurrent IS, TIA, AMI, or vascular death occurred in 14 patients (10%). Of these, 1 new ischemic event (AMI) occurred in a HTPR patient. There was no difference in the frequency of new ischemic events between the HTPR and non-HTPR groups (P = .27); moreover, the number of patients with HTPR was too small for statistical analysis.CONCLUSIONS: Clopidogrel HTPR does not seem to be a major contributor to recurrent ischemic events in Danish ischemic stroke patients.

KW - Aged

KW - Clopidogrel

KW - Denmark

KW - Drug Resistance

KW - Female

KW - Humans

KW - Ischemic Attack, Transient/etiology

KW - Male

KW - Medication Adherence

KW - Middle Aged

KW - Myocardial Infarction/etiology

KW - Platelet Aggregation/drug effects

KW - Platelet Aggregation Inhibitors/adverse effects

KW - Prospective Studies

KW - Recurrence

KW - Risk Factors

KW - Secondary Prevention/methods

KW - Stroke/blood

KW - Ticlopidine/adverse effects

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.jstrokecerebrovasdis.2018.05.027

DO - 10.1016/j.jstrokecerebrovasdis.2018.05.027

M3 - Journal article

C2 - 29945766

SN - 1052-3057

VL - 27

SP - 2683

EP - 2690

JO - Journal of Stroke & Cerebrovascular Diseases

JF - Journal of Stroke & Cerebrovascular Diseases

IS - 10

ER -