Baseline platelet parameters for predicting early platelet response and clinical outcomes in patients with non-cardioembolic ischemic stroke treated with clopidogrel
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Wenxian Li1,*, Xiaomei Xie1,*, Di Wei5,*, Shijun Zhang2, Yuanling Wu1, Xuejun Fu3, Zhen Jing1, Weibiao Lu1, Xinqiang Lai4,# and Li’an Huang1,#
1Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, 510632, P.R. China
2Department of Neurology, People’s Hospital of Zengcheng District, Guangzhou, Guangdong, 510180, P.R. China
3Department of Neurology, People’s Hospital, Second Clinical College, Jinan University, Shenzhen, 518020, P.R. China
4Analysis and Testing Center, Jinan University, Guangzhou, Guangdong, 510632, P.R. China
5Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, 710032, P.R. China
*These authors contributed equally to this work and share first authorship
#These authors contributed equally to this study and share corresponding authorship
Li’an Huang, email: firstname.lastname@example.org
Xinqiang Lai, email: email@example.com
Keywords: mean platelet volume, platelet count, clopidogrel resistance, non-cardioembolic ischemic stroke, platelet response
Received: June 11, 2017 Accepted: September 21, 2017 Published: October 07, 2017
Purpose: The present study investigated whether routine baseline platelet parameters(BPPs) detected before clopidogrel therapy in acute non-cardioembolic ischemic stroke(NCIS) could predict early platelet response and future clinical outcomes.
Results: The CYP2C19 polymorphisms constituted independent risk factors for LCR. The number of female patients, the incidence of diabetes mellitus (DM), the level of low-density lipoprotein(LDL) cholesterol, and the neutrophil-to-lymphocyte ratio(NLR) were significantly high in the clinical clopidogrel resistance (CCR) group. However, none of the BPPs had a significant association with laboratory clopidogrel resistance (LCR) or discriminated with the cut-off values regarding LCR or CCR. The patients were divided into two groups according to the average mean platelet volume(MPV) or platelet count(PC). We found that the HbA1c level, the number of female patients, and the CCR were higher in the groups with elevated MPV (≥ 10.6fL) and PC (≥ 235 × 109/L); the LCR, the NIHSS score at discharge, and elevated MPV and PC were risk predictors for CCR.
Materials and Methods: This study included 196 patients with acute NCIS who underwent routine blood tests upon admission, were treated with clopidogrel, and were followed up for 6 months. Early platelet response was assessed and the CYP2C19 genetic variants were screened for. All participants were categorized into either laboratory clopidogrel resistance(LCR) or clinical clopidogrel resistance (CCR) groups.
Conclusions: Elevated baseline MPV and PC before clopidogrel therapy, as well as CYP2C19 gene variants, should be included in a risk algorithm for NCIS. Furthermore, other nongenetic clinical risk factors should be assessed for optimal prediction of the risk for thrombotic events because of individual variability in platelet response to clopidogrel.
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