Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Neurol Sci. 2021 Jun 15;425:117450. doi: 10.1016/j.jns.2021.117450. Epub 2021 Apr 14.
Clopidogrel is commonly used for secondary stroke prevention in patients with large vessel stenosis. Reduced Clopidogrel high on treatment platelet reactivity (CR) can lead to Clopidogrel underactivity (CU) causing acute thrombosis. However, the prevalence of CU among patients with acute symptomatic carotid disease remains unknown. Therefore, we aimed to find the prevalence and identify the predictors for CU among patients with acutely symptomatic carotid stenosis.
Over the span of 14 months, CR was measured at the time of endovascular procedure in all patients undergoing angiography and stenting because of acute symptomatic carotid stenosis. Only patients treated per institutional protocol with a combination of Clopidogrel and Aspirin were included. CR was measured with VerifyNowP2Y12 reaction units (PRU) and CU was defined as PRU > 208. Patients with CU were compared to those without CU.
Thirty-five patients were included (mean age 71.3 ± 10, 76% men) and twelve (34.3%, mean age 71.8 ± 8.4, 58% men) had CU at the time of endovascular intervention. On univariate analysis more severe carotid stenosis was seen in CU patients (92.6 ± 6.5% vs 81.6 ± 13.6%, p = 0.013) and percent stenosis was independently associated with CU on multivariate analysis (p = 0.023).
CU is present in 1 of every 3 patients with acutely symptomatic carotid disease. The current results suggest that CR testing should become part of routine care in patients with acutely symptomatic carotid disease.
氯吡格雷常用于大血管狭窄患者的二级卒中预防。氯吡格雷治疗中血小板反应性降低（CR）可导致氯吡格雷活性降低（CU），从而引起急性血栓形成。然而，急性症状性颈动脉疾病患者 CU 的患病率尚不清楚。因此，我们旨在确定急性症状性颈动脉狭窄患者 CU 的患病率，并确定其预测因素。
在 14 个月的时间内，对所有因急性症状性颈动脉狭窄而行血管造影和支架置入术的患者，在血管内操作时测量 CR。仅纳入按照机构方案用氯吡格雷和阿司匹林联合治疗的患者。用 VerifyNow P2Y12 反应单位（PRU）测量 CR，PRU＞208 定义为 CU。将 CU 患者与无 CU 患者进行比较。
共纳入 35 例患者（平均年龄 71.3±10 岁，76%为男性），12 例（34.3%，平均年龄 71.8±8.4 岁，58%为男性）在血管内干预时存在 CU。在单因素分析中，CU 患者的颈动脉狭窄更严重（92.6±6.5% vs 81.6±13.6%，p=0.013），多因素分析显示狭窄程度百分比与 CU 独立相关（p=0.023）。
在每 3 例急性症状性颈动脉疾病患者中，就有 1 例存在 CU。目前的结果表明，CR 检测应成为急性症状性颈动脉疾病患者常规治疗的一部分。
