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Related Experiment Videos

Platelet function under aspirin, clopidogrel, and both after ischemic stroke: a case-crossover study.

Armin J Grau1, Sven Reiners, Christoph Lichy

  • 1Neurology Department, University of Heidelberg, Germany. graua@klilu.de

Stroke
|March 15, 2003
PubMed
Summary

Combined aspirin and clopidogrel did not reduce platelet activation markers compared to single drugs in stroke patients. However, combination therapy significantly prolonged collagen-ADP closure times in some patients, suggesting potential benefits and risks.

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Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Hematology

Background:

  • Dual antiplatelet therapy with aspirin and clopidogrel is considered for stroke prevention.
  • The comparative effect of combined versus single antiplatelet agents on platelet activation after stroke is not fully understood.

Purpose of the Study:

  • To investigate if combined aspirin and clopidogrel reduce platelet activation more effectively than either drug alone in patients with a history of atherothrombotic or lacunar stroke.

Main Methods:

  • A case-crossover study involving 31 stroke patients treated sequentially with aspirin, clopidogrel, and both agents for 4 weeks each.
  • Platelet function was assessed using flow cytometry for activation-dependent antigens (CD62p, CD63) and the Platelet Function Analyzer (PFA-100) for collagen/epinephrine (CEPI-CT) and collagen/ADP (CADP-CT) closure times.

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  • Comparisons were made between treatment regimens and with healthy control subjects.

    • Main Results:

    • No significant differences in CD62p or CD63 expression were observed between the three antiplatelet treatment regimens.
    • CD63 expression was higher in stroke patients than in controls, irrespective of treatment.
    • Collagen/epinephrine closure time (CEPI-CT) was prolonged by aspirin and combination therapy compared to clopidogrel alone. Collagen/ADP closure time (CADP-CT) was significantly prolonged by combination therapy compared to monotherapy or controls, particularly in a subgroup of patients.

    Conclusions:

    • Platelet activation, indicated by CD63 expression, remains elevated after stroke and is only partially suppressed by aspirin, clopidogrel, or their combination.
    • The pronounced prolongation of CADP-CT with dual therapy in a subset of patients may suggest reduced thrombotic risk but potentially increased bleeding risk.
    • Further prospective studies are needed to determine the clinical significance and predictive value of these platelet activation parameters.