Clopidogrel Resistance Among Ischemic Stroke Patients and Its Risk Factors in Indonesia
Rakhmad Hidayat1, Rizqi Amanda Nabilah2, Al Rasyid3
1Faculty of Medicine Universitas Indonesia, Indonesia; Dr. Cipto Mangunkusumo Hospital, Indonesia. rhidayat.md@gmail.com.
Insights
Clopidogrel resistance affects 15.8% of Indonesian ischemic stroke patients. Male gender was linked to lower resistance, highlighting potential sex-based differences in antiplatelet therapy response.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Clopidogrel is a key antiplatelet agent for secondary stroke prevention.
- While effective, clopidogrel resistance poses a challenge, particularly in Asian populations.
- Limited research exists on clopidogrel resistance in Indonesia.
Purpose of the Study:
- To investigate the prevalence of clopidogrel resistance in Indonesian patients with ischemic stroke.
- To identify potential risk factors associated with clopidogrel resistance in this cohort.
Main Methods:
- A cross-sectional study involving 57 ischemic stroke patients in Indonesia (2020-2021).
- Clopidogrel resistance was measured using the VerifyNow assay.
- Demographic and clinical data were collected to assess risk factors.
Main Results:
- A 15.8% prevalence of clopidogrel resistance was observed.
- Male gender was significantly associated with reduced clopidogrel resistance (OR 0.2; P=0.006).
- No significant association was found between smoking, hemoglobin, glucose, HbA1c, cholesterol, liver enzymes, urea, or creatinine and clopidogrel resistance.
Conclusions:
- Clopidogrel remains a viable option for preventing recurrent ischemic stroke in Indonesia.
- Further research into genetic polymorphisms may elucidate mechanisms of clopidogrel resistance.
- Understanding resistance patterns can optimize antiplatelet therapy in stroke patients.
Objective:
Clopidogrel is a common antiplatelet used as secondary prevention of ischemic stroke, known to have better efficacy than aspirin, with a equivalent safety profile. However, clopidogrel resistance is not uncommon but has not been widely studied in Asia. This study will further assess clopidogrel resistance and its risk factors.
Materials And Methods:
A cross-sectional study was conducted at Rumah Sakit Universitas, Indonesia, and Rumah Sakit Cipto Mangunkusumo, Indonesia in 2020-2021. All patients had had at least one episode of ischemic stroke. Clopidogrel resistance was assessed using a VerifyNow assay.
Results:
57 subjects were enrolled in this study. We found 15.8% of subjects were clopidogrel resistant. Gender was significantly associated with clopidogrel resistance, with males having 80% lower clopidogrel resistance (OR 0.2 (95% CI 0.022 - 0.638); P=0.006). Meanwhile, smoking was not associated with clopidogrel responsiveness (P=0.051). We found no association between haemoglobin, blood glucose, HbA1c, cholesterol, liver enzymes, serum urea concentration or creatinine levels and clopidogrel resistance.
Conclusion:
Clopidogrel remains an effective treatment to prevent recurrent ischemic stroke in Indonesia. Further studies are needed to assess gene polymorphism and clopidogrel resistance, which may explain the findings of this study.
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