Clopidogrel-Related High Residual Platelet Reactivity Associated with Estimated Glomerular Filtration Rate in Patients with Acute Ischemic Stroke

Cerebrovasc Dis Extra. 2023;13(1):83-89. doi: 10.1159/000534466. Epub 2023 Oct 9.

Abstract

Introduction: There are few studies on the relationship between the occurrence of clopidogrel-related high residual platelet reactivity (HRPR) and estimated glomerular filtration rate (eGFR) at admission in patients with ischemic stroke. The aim of this study was to investigate the possible relationship between the two.

Methods: Patients who were hospitalized and diagnosed with acute ischemic stroke were recruited from July 1, 2017, to June 30, 2018, at Shanghai TCM-Integrated Hospital. Renal function was measured within 24 h of enrollment and eGFR was calculated. Patients were tested for platelet reactivity using the VerifyNow system after 7 days of antiplatelet therapy with clopidogrel 75 mg/d alone, and patients with P2Y12 reaction unit values ≥230 were diagnosed with HRPR. The association between HRPR and eGFR was analyzed.

Results: A total of 274 patients were enrolled in the study, of whom 91 (33.21%) had HRPR. Multivariate logistic regression analysis suggested that an increased risk of HRPR was independently associated with female sex and reduced eGFR (female sex: OR = 2.24, 95% CI: 1.26-3.99, p = 0.006; mild chronic kidney disease [CKD]: OR = 2.95, 95% CI: 1.47-5.93, p = 0.002; moderate CKD: OR = 3.07, 95% CI: 1.08-8.75, p = 0.04).

Conclusion: Decreased eGFR is an independent risk factor for the occurrence of HRPR in patients with ischemic stroke.

Keywords: Chronic kidney disease; Clopidogrel; Estimated glomerular filtration rate; High residual platelet reactivity; Ischemic stroke; Observational study.

MeSH terms

  • China
  • Clopidogrel / adverse effects
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / drug therapy
  • Platelet Aggregation
  • Platelet Aggregation Inhibitors / adverse effects
  • Renal Insufficiency, Chronic* / chemically induced
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / drug therapy
  • Stroke* / diagnosis
  • Stroke* / drug therapy
  • Ticlopidine / adverse effects

Substances

  • Clopidogrel
  • Platelet Aggregation Inhibitors
  • Ticlopidine

Grants and funding

This work was supported by the following funding sources: National Natural Science Foundation of China (82174382); Science and Technology Innovation Action Plan of Shanghai Municipal Science and Technology Commission (20Z21900200); Clinical Research Special Project of Shanghai Municipal Health Commission (20224Y0387).