Clopidogrel High-on-Treatment Platelet Reactivity in Acute Ischemic Stroke Patients
Abstract Background During the first days following an acute ischemic stroke, a consistently good antiplatelet effect of clopidogrel is important due to the increased risk of recurrent ischemia. However, the platelet inhibitory effectiveness of clopidogrel is variable for multifactorial reasons. We...
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Veröffentlicht in: | Thrombosis research 2014-03, Vol.133 (3), p.396-401 |
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description | Abstract Background During the first days following an acute ischemic stroke, a consistently good antiplatelet effect of clopidogrel is important due to the increased risk of recurrent ischemia. However, the platelet inhibitory effectiveness of clopidogrel is variable for multifactorial reasons. We investigated the prevalence and risk factors for clopidogrel high-on-treatment platelet reactivity (clopidogrel-HTPR) in acute ischemic stroke patients. Methods Using multiple-electrode impedance aggregometry (MEA), the antiplatelet effectiveness of clopidogrel in patients with acute ischemic stroke was prospectively evaluated. Measurements were performed 48 h after therapy was either initiated or continued after hospital admission. Clopidogrel-HTPR was defined as ADP-induced values > 47 U. Results A total of 159 patients (71.8 ± 9.8 years, 69 female) were enrolled and 44% (n = 70) patients were clopidogrel-HTPR. 35 of the clopidogrel-HTPR were retested within one week and 57.1% (n = 20) showed a good clopidogrel response during subsequent testing. We identified diabetes mellitus (36.3% vs. 54.4%, p-value = 0.003) and higher HbA1c values (6.3% vs. 6.8%, p = 0.007) as risk factors for clopidogrel-HTPR. Multivariate regression analysis revealed that diabetes mellitus more than doubled the risk of clopidogrel-HTPR (OR 2.41; 95%-CI 1.19-4.88; p = 0.015). Conclusions Clopidogrel-HTPR was found in 44% of the patients with acute ischemic stroke. Besides time-dependency of the clopidogrel effect, major risk factors for clopidogrel-HTPR were diabetes mellitus and higher HbA1c values. Further investigations are required to analyse if a function test guided strategy has the potential to optimize the antiplatelet therapy of acute stroke patients. |
doi_str_mv | 10.1016/j.thromres.2013.12.002 |
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However, the platelet inhibitory effectiveness of clopidogrel is variable for multifactorial reasons. We investigated the prevalence and risk factors for clopidogrel high-on-treatment platelet reactivity (clopidogrel-HTPR) in acute ischemic stroke patients. Methods Using multiple-electrode impedance aggregometry (MEA), the antiplatelet effectiveness of clopidogrel in patients with acute ischemic stroke was prospectively evaluated. Measurements were performed 48 h after therapy was either initiated or continued after hospital admission. Clopidogrel-HTPR was defined as ADP-induced values > 47 U. Results A total of 159 patients (71.8 ± 9.8 years, 69 female) were enrolled and 44% (n = 70) patients were clopidogrel-HTPR. 35 of the clopidogrel-HTPR were retested within one week and 57.1% (n = 20) showed a good clopidogrel response during subsequent testing. We identified diabetes mellitus (36.3% vs. 54.4%, p-value = 0.003) and higher HbA1c values (6.3% vs. 6.8%, p = 0.007) as risk factors for clopidogrel-HTPR. Multivariate regression analysis revealed that diabetes mellitus more than doubled the risk of clopidogrel-HTPR (OR 2.41; 95%-CI 1.19-4.88; p = 0.015). Conclusions Clopidogrel-HTPR was found in 44% of the patients with acute ischemic stroke. Besides time-dependency of the clopidogrel effect, major risk factors for clopidogrel-HTPR were diabetes mellitus and higher HbA1c values. Further investigations are required to analyse if a function test guided strategy has the potential to optimize the antiplatelet therapy of acute stroke patients.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2013.12.002</identifier><identifier>PMID: 24406048</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Aged ; Blood Platelets - drug effects ; Blood Platelets - physiology ; Cardiography, Impedance ; Clopidogrel ; Female ; Hematology, Oncology and Palliative Medicine ; High-on-Treatment Platelet Reactivity ; Humans ; Impedance Aggregometry ; Male ; Platelet Aggregation ; Platelet Aggregation - drug effects ; Platelet Aggregation Inhibitors - therapeutic use ; Risk Factors ; Stroke ; Stroke - blood ; Stroke - drug therapy ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use</subject><ispartof>Thrombosis research, 2014-03, Vol.133 (3), p.396-401</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-ba380ddec1eb813becdf2726e29d446a884666a140afe2ddd87e3e68f38cd5d83</citedby><cites>FETCH-LOGICAL-c423t-ba380ddec1eb813becdf2726e29d446a884666a140afe2ddd87e3e68f38cd5d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.thromres.2013.12.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24406048$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meves, Saskia H</creatorcontrib><creatorcontrib>Schröder, Kay D</creatorcontrib><creatorcontrib>Endres, Heinz G</creatorcontrib><creatorcontrib>Krogias, Christos</creatorcontrib><creatorcontrib>Krüger, Jan C</creatorcontrib><creatorcontrib>Neubauer, Horst</creatorcontrib><title>Clopidogrel High-on-Treatment Platelet Reactivity in Acute Ischemic Stroke Patients</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>Abstract Background During the first days following an acute ischemic stroke, a consistently good antiplatelet effect of clopidogrel is important due to the increased risk of recurrent ischemia. However, the platelet inhibitory effectiveness of clopidogrel is variable for multifactorial reasons. We investigated the prevalence and risk factors for clopidogrel high-on-treatment platelet reactivity (clopidogrel-HTPR) in acute ischemic stroke patients. Methods Using multiple-electrode impedance aggregometry (MEA), the antiplatelet effectiveness of clopidogrel in patients with acute ischemic stroke was prospectively evaluated. Measurements were performed 48 h after therapy was either initiated or continued after hospital admission. Clopidogrel-HTPR was defined as ADP-induced values > 47 U. Results A total of 159 patients (71.8 ± 9.8 years, 69 female) were enrolled and 44% (n = 70) patients were clopidogrel-HTPR. 35 of the clopidogrel-HTPR were retested within one week and 57.1% (n = 20) showed a good clopidogrel response during subsequent testing. We identified diabetes mellitus (36.3% vs. 54.4%, p-value = 0.003) and higher HbA1c values (6.3% vs. 6.8%, p = 0.007) as risk factors for clopidogrel-HTPR. Multivariate regression analysis revealed that diabetes mellitus more than doubled the risk of clopidogrel-HTPR (OR 2.41; 95%-CI 1.19-4.88; p = 0.015). Conclusions Clopidogrel-HTPR was found in 44% of the patients with acute ischemic stroke. Besides time-dependency of the clopidogrel effect, major risk factors for clopidogrel-HTPR were diabetes mellitus and higher HbA1c values. Further investigations are required to analyse if a function test guided strategy has the potential to optimize the antiplatelet therapy of acute stroke patients.</description><subject>Aged</subject><subject>Blood Platelets - drug effects</subject><subject>Blood Platelets - physiology</subject><subject>Cardiography, Impedance</subject><subject>Clopidogrel</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>High-on-Treatment Platelet Reactivity</subject><subject>Humans</subject><subject>Impedance Aggregometry</subject><subject>Male</subject><subject>Platelet Aggregation</subject><subject>Platelet Aggregation - drug effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - blood</subject><subject>Stroke - drug therapy</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctOGzEUhq2KCgLlFdAsu5nBt3g8m6ooagsSEqiha8uxzxAHzzjYHqS8fR0FWLBhdTb_Ref7EboguCGYiMtNk9cxDBFSQzFhDaENxvQLmhHZdjXlLT1CM4x5VzPJ5Qk6TWmDMWlJNz9GJ5RzLDCXM7Rc-LB1NjxG8NW1e1zXYawfIug8wJire68zeMjVX9AmuxeXd5UbqyszZahuklnD4Ey1zDE8QXWvsyum9A197bVPcP56z9C_378eFtf17d2fm8XVbW04ZbleaSaxtWAIrCRhKzC2py0VQDvLudBSciGEJhzrHqi1VrbAQMieSWPnVrIz9P2Qu43heYKU1eCSAe_1CGFKivCuI3PGOl6k4iA1MaQUoVfb6AYdd4pgtQeqNuoNqNoDVYSqArQYL147ptUA9t32RrAIfh4EUD59cRBVMoWCAesimKxscJ93_PgQYbwbndH-CXaQNmGKY-GoiErFoJb7WferEobxXLQt-w8986Cu</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Meves, Saskia H</creator><creator>Schröder, Kay D</creator><creator>Endres, Heinz G</creator><creator>Krogias, Christos</creator><creator>Krüger, Jan C</creator><creator>Neubauer, Horst</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Clopidogrel High-on-Treatment Platelet Reactivity in Acute Ischemic Stroke Patients</title><author>Meves, Saskia H ; Schröder, Kay D ; Endres, Heinz G ; Krogias, Christos ; Krüger, Jan C ; Neubauer, Horst</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-ba380ddec1eb813becdf2726e29d446a884666a140afe2ddd87e3e68f38cd5d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Blood Platelets - drug effects</topic><topic>Blood Platelets - physiology</topic><topic>Cardiography, Impedance</topic><topic>Clopidogrel</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>High-on-Treatment Platelet Reactivity</topic><topic>Humans</topic><topic>Impedance Aggregometry</topic><topic>Male</topic><topic>Platelet Aggregation</topic><topic>Platelet Aggregation - drug effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - blood</topic><topic>Stroke - drug therapy</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meves, Saskia H</creatorcontrib><creatorcontrib>Schröder, Kay D</creatorcontrib><creatorcontrib>Endres, Heinz G</creatorcontrib><creatorcontrib>Krogias, Christos</creatorcontrib><creatorcontrib>Krüger, Jan C</creatorcontrib><creatorcontrib>Neubauer, Horst</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meves, Saskia H</au><au>Schröder, Kay D</au><au>Endres, Heinz G</au><au>Krogias, Christos</au><au>Krüger, Jan C</au><au>Neubauer, Horst</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clopidogrel High-on-Treatment Platelet Reactivity in Acute Ischemic Stroke Patients</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>133</volume><issue>3</issue><spage>396</spage><epage>401</epage><pages>396-401</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><abstract>Abstract Background During the first days following an acute ischemic stroke, a consistently good antiplatelet effect of clopidogrel is important due to the increased risk of recurrent ischemia. However, the platelet inhibitory effectiveness of clopidogrel is variable for multifactorial reasons. We investigated the prevalence and risk factors for clopidogrel high-on-treatment platelet reactivity (clopidogrel-HTPR) in acute ischemic stroke patients. Methods Using multiple-electrode impedance aggregometry (MEA), the antiplatelet effectiveness of clopidogrel in patients with acute ischemic stroke was prospectively evaluated. Measurements were performed 48 h after therapy was either initiated or continued after hospital admission. Clopidogrel-HTPR was defined as ADP-induced values > 47 U. Results A total of 159 patients (71.8 ± 9.8 years, 69 female) were enrolled and 44% (n = 70) patients were clopidogrel-HTPR. 35 of the clopidogrel-HTPR were retested within one week and 57.1% (n = 20) showed a good clopidogrel response during subsequent testing. We identified diabetes mellitus (36.3% vs. 54.4%, p-value = 0.003) and higher HbA1c values (6.3% vs. 6.8%, p = 0.007) as risk factors for clopidogrel-HTPR. Multivariate regression analysis revealed that diabetes mellitus more than doubled the risk of clopidogrel-HTPR (OR 2.41; 95%-CI 1.19-4.88; p = 0.015). Conclusions Clopidogrel-HTPR was found in 44% of the patients with acute ischemic stroke. Besides time-dependency of the clopidogrel effect, major risk factors for clopidogrel-HTPR were diabetes mellitus and higher HbA1c values. Further investigations are required to analyse if a function test guided strategy has the potential to optimize the antiplatelet therapy of acute stroke patients.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>24406048</pmid><doi>10.1016/j.thromres.2013.12.002</doi><tpages>6</tpages></addata></record> |
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subjects | Aged Blood Platelets - drug effects Blood Platelets - physiology Cardiography, Impedance Clopidogrel Female Hematology, Oncology and Palliative Medicine High-on-Treatment Platelet Reactivity Humans Impedance Aggregometry Male Platelet Aggregation Platelet Aggregation - drug effects Platelet Aggregation Inhibitors - therapeutic use Risk Factors Stroke Stroke - blood Stroke - drug therapy Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use |
title | Clopidogrel High-on-Treatment Platelet Reactivity in Acute Ischemic Stroke Patients |
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