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Risk of stroke in patients with high on-clopidogrel platelet reactivity to adenosine diphosphate after percutaneous

Nevio Taglieri1, Maria Letizia Bacchi Reggiani1, Tullio Palmerini1

  • 1Istituto di Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy.

The American Journal of Cardiology
|May 20, 2014
PubMed

Insights

High on-clopidogrel platelet reactivity (HPR) increases stroke risk in patients undergoing percutaneous coronary intervention (PCI). This systematic review confirms HPR as a significant risk factor for stroke in this population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Neurology

Background:

  • High on-clopidogrel platelet reactivity (HPR) is a known risk factor for ischemic events after percutaneous coronary intervention (PCI).
  • Previous studies lacked the power to definitively link HPR to an increased risk of stroke.
  • A need exists to systematically evaluate the association between HPR and stroke incidence in PCI patients.

Purpose of the Study:

  • To determine if patients undergoing PCI with HPR face an elevated risk of stroke.
  • To conduct a systematic review and meta-analysis of existing prospective studies.

Main Methods:

  • Systematic review and meta-analysis of 14 prospective studies.
  • Inclusion criteria: patients undergoing PCI, treated with aspirin and clopidogrel, reporting on HPR to adenosine diphosphate.
  • Primary endpoint: stroke rate. Investigated interactions with clinical presentation, follow-up duration, and laboratory methods.

Main Results:

  • Pooled analysis of 11,959 patients revealed a higher stroke risk in patients with HPR (1.2%) compared to those without (0.7%).
  • Relative risk of stroke for HPR patients was 1.84 (95% CI 1.21 to 2.80).
  • No significant interaction was found between HPR and clinical presentation, follow-up duration, or laboratory methods for detecting HPR.

Conclusions:

  • High on-clopidogrel platelet reactivity is a significant risk factor for stroke in patients with coronary artery disease undergoing PCI.
  • The increased stroke risk associated with HPR is consistent across different clinical presentations, follow-up durations, and laboratory detection methods.
  • These findings underscore the importance of monitoring and potentially managing HPR in PCI patients to mitigate stroke risk.

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