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Severe, Intolerable Fatigue Associated with Hyperresponse to Clopidogrel.

David I Bass1, Christopher C Young1, Min S Park2

  • 1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.

World Neurosurgery
|September 26, 2021
PubMed
Summary

Severe fatigue is a rare side effect of clopidogrel in neuroendovascular procedures. This study found that hyperresponse to clopidogrel, identified by platelet function testing, can cause severe fatigue in some patients.

Keywords:
ClopidogrelFatigueIntracranial aneurysmStentSyndromeVerifyNow

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Area of Science:

  • Neuroendovascular procedures
  • Pharmacology
  • Clinical Neurology

Background:

  • Clopidogrel is a key antiplatelet medication used after neuroendovascular procedures.
  • Anecdotal reports suggest clopidogrel may cause severe fatigue.
  • Systematic investigation is needed to confirm this potential side effect.

Purpose of the Study:

  • To investigate the association between clopidogrel and severe fatigue in patients undergoing neuroendovascular procedures.
  • To determine the incidence and characteristics of clopidogrel-induced severe fatigue.

Main Methods:

  • Retrospective study of 349 patients receiving clopidogrel for neuroendovascular procedures over 9 years.
  • Platelet function testing using VerifyNow P2Y12 (VNP) assay to assess clopidogrel response.
  • Defined hyperresponse as P2Y12 reaction units ≤60 and clopidogrel-induced severe fatigue based on symptom onset, improvement with dose reduction, and exclusion of other causes.

Main Results:

  • Five patients (1.4%) met criteria for clopidogrel-induced severe fatigue.
  • All affected patients were female, aged 39-68, and exhibited hyperresponse (0-22 VNP units) while symptomatic.
  • Symptom improvement occurred after halving the clopidogrel dose; 30% of patients showed hyperresponse, but most did not develop severe fatigue.

Conclusions:

  • Severe fatigue is a rare but significant side effect of clopidogrel in neuroendovascular intervention patients.
  • Hyperresponse to clopidogrel is linked to this fatigue syndrome.
  • Platelet function testing can identify patients at risk.