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Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population

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Abstract

To evaluate the prevalence and risk factors of antiplatelet drug resistance and its association with early neurological deterioration (END) and recurrent ischemic stroke (RIS) in patients with acute minor stroke. Antiplatelet drug resistance was assessed by platelet aggregation assay in 426 patients with minor stroke who were receiving combined treatment of aspirin and clopidogrel. All patients were followed up for 90 days. The primary endpoint of the study was END within 10 days after admission. The secondary endpoints included RIS, myocardial infarction and death during 90 days of treatment. The safety endpoints were intracerebral or extracranial hemorrhagic events. Cox proportional hazard regression analysis was performed to determine the risk factors for the primary endpoint and secondary endpoints. Among the 426 patients, 24.4 % exhibited aspirin resistance, 35.9 % exhibited clopidogrel resistance, and 19.2 % displayed concomitant aspirin and clopidogrel resistance. In multivariate analysis, diabetes mellitus and high level of low density lipoprotein-cholesterol were independent risk factors for aspirin resistance, while diabetes mellitus was the only independent risk factor for clopidogrel resistance. END was observed in 93 (21.8 %) patients. Diabetes mellitus, high fasting blood glucose level, and concomitant aspirin and clopidogrel resistance were independent risk factors for END. RIS was observed in 40 (9.4 %) patients. Diabetes mellitus, hypertension, and concomitant aspirin and clopidogrel resistance were independent risk factors for RIS. Antiplatelet drug resistance is common in acute minor ischemic stroke patients and is associated with END and RIS after acute minor ischemic stroke in the Chinese population.

Clinical Trial Registration Information: http://www.chictr.org/. Unique Identifier: ChiCTR-OCH-14004724.

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Acknowledgments

This study was supported in part by grants from the Deyang City Science and Technology Research Foundation (#2014SZ035) and the Scientific Research Foundation of Chengdu University of Traditional Chinese Medicine (# YYZX1510).

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Authors and Affiliations

  1. Department of Neurology, People’s Hospital of Deyang City, No 173, North Taishan Road, Deyang, 618000, Sichuan, China

    Xingyang Yi, Chun Wang & Ping Liu

  2. Department of Neurology, Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325200, Zhejiang, China

    Cheng Fu, Jing Lin & Yiming Chen

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  1. Xingyang Yi
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Correspondence to Xingyang Yi.

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The study protocol was approved by the Ethics Committee at the participating hospitals in accordance with the principles stated in the Declaration of Helsinki.

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Written informed consent was obtained from all the participants.

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Yi, X., Wang, C., Liu, P. et al. Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population. J Neurol 263, 1612–1619 (2016). https://doi.org/10.1007/s00415-016-8181-5

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