THE VASCULAR RISK FACTORS ASSOCIATED WITH ANTIPLATELET RESISTANCE IN ISCHEMIC STROKE PATIENTS
Objectives: This research is to measure the prevalence rate of antiplatelet resistance in ischemic stroke patients and measure the vascular risk factors associated with antiplatelet resistance in patients with ischemic stroke.
Methods and Subjects: This was a cross-sectional study with the number of respondents in this study amounted to 155 patients who all had ischemic stroke disease at Bethesda Hospital in Yogyakarta Indonesia used stroke registry to complete the data of the risk factors. VerifyNow method is used to measure the responsiveness of antiplatelet therapy.
Results: Among the 155 patients with ischemic stroke, 45 were women (29%), 110 were men (71%), and the elderly (age more than 60 years old) in 81 patients. In total 155 patients with ischemic stroke, 106 of them have hypertensive, with diabetes are 19 patients, dyslipidemia is 90 patients, and ischemic heart disease in 13 patients. The prevalence of antiplatelet resistance in risk factors, for age more than 60 years, is 21 patients (25%, RR=1.06, *p=0.96), in diabetes is 7 patients (36%, RR=1.17, **p=0.74), dyslipidemia is 19 patients (21%, RR=0.68, ***p=0.24), and ischemic heart disease is four patients (30%). Among 127 patients, 22% (28 patients) had aspirin resistance, while from 42 patients, 26.2% (11 patients) were resistant to clopidogrel.
Conclusion: Antiplatelet resistance is common in ischemic stroke patients. One of five patients treated with antiplatelet showed non-responsiveness. Vascular risk factors do not increase the risk of antiplatelet resistance in ischemic stroke patients.
2. Power WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American stroke association. Stroke 2018;49:46-110.
3. Centers for Disease Control and Prevention. Global Burden Compare: Global Stroke Disease. Atlanta, Georgia, United States: Centers for Disease Control and Prevention; 2017. Available from: https://www. vizhub.healthdata.org/gbd-compare. [Last assessed 2019 Oct 24].
4. Putaala J, Yesilot N, Waje-Andreassen U, Janne P, Sofia V, Katiuscia N, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: The 15 cities young stroke study. Stroke 2012;43:2624-30.
5. Hossain AM, Ahmed NU, Rahman M, Islam MR, Sadhya G, Faridpur KF. Analysis of sociodemographic and clinical factors associated with hospitalized stroke patients of Bangladesh. Faridpur Med Coll J 2011;6:19-23.
6. Kameshwar P, Reed S, Qiukui H, Gordon G, Martin O, Lyubov L. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: A clinical practice guideline. BMJ 2018;363:k5130.
7. Spurthi T, Gowthami B, Khyathi D, Vinod G. Risk elements and drug utilization in stroke patient. Int J Pharm Pharm Sci 2016;10:290-2.
8. Venkateswaramurthy N, Krishnaveni K, Freeda RM, Kumar RS. Assessment of potential drug-drug interaction in stroke patients. Int J Pharm Pharm Sci 2016;8:221-4.
9. Wagle L, Thomas A, Shrestha S. Drug utilisation study of stroke and other patients admitted to general ward of neurology unit at quaternary care private hospital. Int J Curr Pharm Res 2017;9:23.
10. Sadeghi M, Emami A, Ziyaei N, Majid Y, Allahyar G, Azam S. Aspirin resistance and ischemic heart disease on Iranian experience. Adv Biomed Res 2012;1:33.
11. Topcuoglu MA, Arsava EM, Hakan A. Antiplatelet resistance in stroke. Expert Rev Neurother 2011;11:251-63.
12. Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res2017;120:472-95.
13. Brain Edema: Ismail Setyopranoto. Patients with Acute Ischemic Stroke. Vol. 8. Indonesia: Gadjah Mada University Faculty of Medicine Publishing; 2012.
14. Jung KH, Kyung LH, Kyunja H, Kyung KH. Prevalence and risk factors for aspirin and clopidogrel resistance in patients with coronary artery disease or ischemic cerebrovascular disease. Ann Clin Lab Sci 2009;39:289-94.
16. Zheng AS, Churilov L, Colley RE, Christine G, Stephen MD, BernardY. Association of aspirin resistance with increased stroke severity and infarct size. JAMA Neurol 2013;70:208-13.
17. Yi X, Lin J, Zhou Q, Wu L, Cheng W, Wang C. Clopidogrel resistance increases the rate of recurrent stroke and other vascular events in Chinese population. J Stroke Cerebrovasc Dis 2016;25:1222-8.
18. Jain K, Deore D. Bioanalytical method development and validation for estimation of clopidogrel bisulfate in human plasma by RP-HPLC. Int J Appl Pharm 2016;8:28-33.
19. Yi X, Wang C, Liu P, Fu C, Lin J, Chen Y. Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population. J Neurol 2016;263:1612-9.
20. Samir P, Agrawal CS, Vandang A, Amrita S, Manorama B. Aspirin and clopidogrel resistance in indian patients with ischemic stroke and its associations with gene polymorphisms: A pilot study. Ann Indian Acad Neurol 2019;22:147-52.
21. Kasoktasis G, Pipinos II, Lynch TG. Current evidence and clinical implication of aspirin resistance. J Vasc Surg 2009;50:1500-10.
22. Beste O, Azra MT, Tomris O, Oguz C. Aspirin resistance in hypertensive patients. J Clin Hypertens 2010;12:714-20.
23. Hedegaard SS, Hvas AM, Grove EL, Jens R, Bianca R, Giovanni D, et al. Optical platelet aggregation versus thromboxane metabolites in healthy individuals and patients with stable coronary artery disease after low-dose aspirin administration. Thromb Res 2009;124:96-100.
24. Ibrahim AF, Fatma CN, Mehmet E, Nilgun T, Ahmet AF, Ozgur S, et al. Hypertension as a risk factor for aspirin and clopidogrel resistance in patients with stable coronary artery disease. Clin Appl Thromb Hemost 2014;20:749-54.
25. Angiolillo DJ, Bernardo E, Ramirez C, Costa MA, Sabate M, Jimenez QP, et al. Insulin therapy is associated with platelet dysfunction in patients with Type 2 diabetes mellitus on dual oral antiplatelet treatment. J Am Coll Cardiol 2006;48:298-304.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.