Platelet reactivity to adenosine diphosphate and genotypes are linked with carotid plaques and may predict carotid plaque stability in acute ischemic stroke patients.

OBJECTIVES

To determine the correlations of ADP-induced platelet-inhibition rate (ADP-PIR) and genotypes with carotid plaque types in acute ischemic stroke (AIS). Unstable carotid plaques are implicated in AIS. Clopidogrel (commonly prescribed in AIS) produces adenosine diphosphate (ADP)-induced platelet inhibition, and is metabolized by .

METHODS

We retrospectively evaluated the data of AIS patients treated at our hospital during 2019-2022, and administered maintenance clopidogrel (75 mg/d). Carotid plaques, ADP-PIR, and genotypes were assessed using color Doppler ultrasonography, thromboelastography, and polymerase chain reaction assays, respectively. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.

RESULTS

Of 692 study patients, 378 (54.6%) and 128 (18.5%) had unstable and stable carotid plaques, respectively. Multivariate logistic regression identified PIR and genotype as independent risk factors for stable carotid plaque (PIR, OR: 0.984, 95% CI: 0.974-0.995, =0.003; intermediate metabolizer, OR: 0.158, 95% CI: 0.066-0.379, <0.001; poor metabolizer, OR: 0.584, 95% CI: 0.155-2.206, =0.428) and unstable carotid plaque (PIR, OR: 0.957, 95% CI: 0.949-0.966, <0.001; intermediate metabolizer, OR: 0.151, 95% CI: 0.063-0.362, <0.001; poor metabolizer, OR: 0.145, 95% CI: 0.051-0.416, <0.001). Areas under the ROC curve for predicting unstable and stable carotid plaques were 0.700 (PIR) and 0.716 ( genotype), and 0.631 (PIR) and 0.650 ( genotype), respectively.

CONCLUSION

The PIR and genotype are correlated with and may predict carotid plaque types in AIS.