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Clopidogrel increases risk of pneumonia compared with aspirin in acute ischemic minor stroke patients

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Abstract

Antiplatelet agents may increase the risk of infections via suppressing platelet-mediated immune response. Here we assessed the contribution of clopidogrel versus aspirin to the development of pneumonia during an acute ischemic stroke admission. A retrospective cohort study was conducted of acute ischemic stroke patients who were admitted to our hospital from 2015 to 2018. Included patients received uninterrupted clopidogrel or aspirin therapy and did not take other antiplatelet agents throughout their stay. The interest outcome was development of pneumonia after stroke. Conditional logistic regression model after propensity score matching and adjusted logistic regression model were used to assess the impact of clopidogrel versus aspirin on post-stroke pneumonia. Among 1470 included patients, 1135 received aspirin and 335 received clopidogrel. Total 149 patients (10.1%) experienced pneumonia during the stroke hospitalization period. No difference was observed between clopidogrel cohort and aspirin cohort in the incidence of post-stroke pneumonia after propensity score matching (relative risk, 1.04; 95% confidence interval (CI) 0.65–1.65; P = 0.875). However, we found that clopidogrel was associated with increased risk of pneumonia compared with aspirin in minor stroke patients (adjusted odds ratio, 2.21; 95% CI 1.12–4.34; P = 0.021), and a statistically insignificant increase of pneumonia in diabetics (adjusted odds ratio, 1.94; 95% CI 0.96–3.94; P = 0.065). Compared with aspirin, clopidogrel is associated with increased pneumonia in minor stroke patients among who the interference of stroke-induced immunosuppression is minimized. Hence, aspirin may be a better choice for minor stroke patients in acute phase of ischemic stroke when pneumonia most frequently occurs.

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Funding

This study was supported by grants from Suzhou Municipal Science and Technology Bureau (SYS2019093 and SYS201428).

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Author notes

  1. Zhangfeng Yu and Hua Zhou have contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China

    Zhangfeng Yu

  2. Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China

    Hua Zhou, Baoshuai Shan, Jianzhong Fu, Hao Zhu, Qian Feng & Rong Shen

  3. Department of Clinical Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita West Road, Suzhou, 215001, Jiangsu Province, China

    Xing Jin

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  1. Zhangfeng Yu
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Contributions

ZY, HZ and XJ wrote the manuscript; XJ, ZY, HZ, BS, JF, HZ and QF designed the research; ZY, HZ, JF, HZ, QF and RS performed the research; XJ and BS conducted the statistical analyses and interpreted the data.

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Correspondence to Xing Jin.

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Ethics approval The Institutional Review Board at Affiliated Suzhou Hospital of Nanjing Medical University approved this study with a waiver of informed consent (Institutional Review Board Number: KL901057).

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Yu, Z., Zhou, H., Shan, B. et al. Clopidogrel increases risk of pneumonia compared with aspirin in acute ischemic minor stroke patients. J Thromb Thrombolysis 52, 301–307 (2021). https://doi.org/10.1007/s11239-020-02306-1

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