High on-treatment platelet reactivity as predictor of long-term clinical outcomes in stroke patients with antiplatelet agents
Authors
Huihui Lv, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Zidong Yang, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
Haibo Wu, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Mingyuan Liu, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Xiaowei Mao, Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Xu Liu, School of Life Sciences, Fudan University, Shanghai, China.
Hongyan Ding, Department of Neurology, Huashan Hospital, Fudan University, 12 Urumqi Zhong Lu, Shanghai, China.
Zhuqing Shi, School of Life Sciences, Fudan University, Shanghai, China.
Yang Zhou, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Qianyun Liu, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Yongkang Zhang, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Yinting Zhou, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China.
Kai Chen, Advocate Aurora Health
Zezhi Li, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Qiang Dong, Department of Neurology, Huashan Hospital, Fudan University, 12 Urumqi Zhong Lu, Shanghai, China. dong_qiang@fudan.edu.cn.
Jianpeng Ma, Multiscale Research Institute of Complex Systems, Fudan University, 220 Handan Road, Shanghai, China. jpma@bcm.edu.
Yan Han, Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, China. hanyan@shutcm.edu.cn.
Recommended Citation
Lv H, Yang Z, Wu H, et al. High On-Treatment Platelet Reactivity as Predictor of Long-term Clinical Outcomes in Stroke Patients with Antiplatelet Agents. Transl Stroke Res. 2022;13(3):391-398. doi:10.1007/s12975-021-00949-7
Abstract
The purpose was to explore the value of high on-treatment platelet reactivity (HTPR) in predicting long-term clinical outcomes for stroke patients. The platelet reactivity was assayed after being treated with either 75 mg clopidogrel or 100 mg aspirin daily with VerifyNow System in stroke patients. HTPR for clopidogrel was defined as PRU ≥ 208, and that for aspirin was defined as ARU ≥ 550. CYP2C19 genotyping was performed using the Sequenom MassARRAY iPLEX platform. The primary endpoint was a composite of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or ischemic vascular death. The safety endpoint was bleeding. In the clopidogrel group, among 345 patients recruited, 174 of them were categorized as HTPR. A total of 270 patients were followed up for 54 months. There was a significant association between HTPR and the primary endpoint (HR 2.13 [95% CI, 1.43-3.15], p < 0.001). Among the 314 participants genotyped for CYP2C19, 187 (59.6%) were classified as CYP2C19 loss-of-function allele carriers. Patients with at least 1 loss-of-function allele were more likely to present with HTPR (OR 2.61 [95%CI, 1.43-4.77], p = 0.008), and had a higher risk of the primary endpoint (HR 2.05 [95% CI, 1.30, 3.25], p = 0.002). In the aspirin group, among 140 patients recruited, 28 of them were categorized as HTPR. A total of 121 patients were followed up for 30 months. Similarly, there was a significant association between HTPR and the primary endpoint (HR 3.28 [95% CI, 1.52-7.71], p = 0.002). HTPR is an independent risk factor for ischemic events during long-term follow-up in stroke patients. Platelet function testing is helpful to evaluate the effect of antiplatelet therapy for stroke patients.
Affiliations
Maternal Fetal Medicine, Aurora Medical Group, Sinai Medical Center