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Article

A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke

1
Department of Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
2
Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland
*
Author to whom correspondence should be addressed.
Academic Editors: Jerónimo González-Bernal and Raúl Soto-Cámara
Healthcare 2021, 9(6), 628; https://doi.org/10.3390/healthcare9060628
Received: 27 April 2021 / Revised: 19 May 2021 / Accepted: 23 May 2021 / Published: 25 May 2021
(This article belongs to the Special Issue Consequences of Stroke)
Background: The combined use of clopidogrel and aspirin is recommended for the short-term (21 days) therapy of minor stroke or transient ischemic attack. Previous studies have demonstrated its efficacy and superiority over treatment with a single antiplatelet agent. However, there is insufficient support for the advantages of such therapy based on platelet function testing. We aimed to compare the effect of the concomitant use of clopidogrel and aspirin versus clopidogrel alone on the dynamics of platelet reactivity over time to determine the appropriate antiplatelet treatment strategy for minor strokes. Methods: We enrolled 74 ischemic stroke subjects, including 38 minor strokes. Platelet reactivity was assessed by impedance aggregometry (Multiplate Analyzer) 48 and 96 h after a first 75 mg dose of clopidogrel, using the acetylsalicylic acid platelet inhibition (ASPI) test and the adenosine diphosphate (ADP) test. Dual antiplatelet therapy was strictly reserved only to minor strokes, as the other strokes received clopidogrel alone in the secondary prevention. The dynamics of platelet reactivity refer to the difference between two assessments, and a decrease in values over time was considered favorable. Results: The incidence of clopidogrel non-responsiveness was 64.8%, and this was similar in the group of minor strokes and the group of more disabling strokes. We indicated diabetes mellitus as an independent predictor of high on-clopidogrel platelet reactivity (Odds ratio OR 5.69 95% Confidence Interval CI 1.13–41.26, p = 0.0386). Among minor strokes treated with dual antiplatelet therapy, in relation to clopidogrel, we reported a trend toward more favorable dynamics of platelet reactivity over time compared to the group using clopidogrel alone (p = 0.0652 vs. p = 0.3384, respectively). We identified five predictors (sex, female; small-vessel disease; no diabetes; no hyperlipidemia; and no alcohol abuse) related to a significant decrease in platelet reactivity over time with respect to clopidogrel. No significant dynamics of platelet reactivity when using aspirin were found. Conclusions: Our findings, based on the favorable dynamics of platelet reactivity over time in relation to clopidogrel, confirm the usefulness of dual antiplatelet therapy in minor strokes and support the continuation of the secondary prevention with clopidogrel alone rather than aspirin, particularly among identified beneficiaries of such a strategy. View Full-Text
Keywords: stroke; cerebrovascular diseases; prevention; dual antiplatelet therapy; clopidogrel; aspirin; platelet reactivity stroke; cerebrovascular diseases; prevention; dual antiplatelet therapy; clopidogrel; aspirin; platelet reactivity
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MDPI and ACS Style

Wiśniewski, A.; Sikora, J.; Karczmarska-Wódzka, A.; Sobczak, P. A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke. Healthcare 2021, 9, 628. https://doi.org/10.3390/healthcare9060628

AMA Style

Wiśniewski A, Sikora J, Karczmarska-Wódzka A, Sobczak P. A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke. Healthcare. 2021; 9(6):628. https://doi.org/10.3390/healthcare9060628

Chicago/Turabian Style

Wiśniewski, Adam, Joanna Sikora, Aleksandra Karczmarska-Wódzka, and Przemysław Sobczak. 2021. "A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke" Healthcare 9, no. 6: 628. https://doi.org/10.3390/healthcare9060628

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