Highlights
- •Clopidogrel underactivity prevalence in acute symptomatic carotid patients is unknown.
- •Clopidogrel reactivity was measured at the beginning of endovascular procedure
- •35 patients were included and 12 showed clopidogrel underactivity.
- •More severe carotid stenosis was seen in clopidogrel underactivity patients.
- •% stenosis was associated with clopidogrel underactivity on multivariate analysis
Abstract
Background
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.
Patients and methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: April 14, 2021
Accepted:
April 12,
2021
Received in revised form:
April 9,
2021
Received:
November 22,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
