Analysis on risk factors of clopidogrel resistance in patients with ischemic stroke
10.12206/j.issn.2097-2024.202209054
- VernacularTitle:缺血性脑卒中患者发生氯吡格雷抵抗的危险因素分析
- Author:
Yajuan WANG
1
,
2
;
Yan ZHAO
2
;
Weiliang LI
2
;
Airong YU
2
Author Information
1. Hubei University of Science and Technology, Xianning 437000, China
2. Department of Clinical Pharmacy, Central Theater General Hospital, Wuhan 430070, China.
- Keywords:
ischemic stroke;
clopidogrel resistance;
thromboelastographic;
cytochrome oxidase P450 enzyme 2C19;
risk factors
- From:
Journal of Pharmaceutical Practice and Service
2024;42(1):32-37
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors of drug resistance in patients with ischemic stroke by clopidogrel therapy and provide references for promoting clinical individualized drug therapy. Methods A total of 202 inpatients diagnosed with ischemic stroke were admitted and given dual anti-treatment (aspirin+clopidogrel). CYP2C19 genotype was detected by microarray hybridization during hospitalization, and CYP2C19 gene polymorphisms were classified into fast metabolism group, medium metabolism group and slow metabolism group according to the type of drug metabolism. Patients were tested for platelet inhibition induced by adenosine diphosphate (ADP) according to thromboelastographic (TEG) on 7~14 d of drug administration. ADP <30% was classified as clopidogrel drug resistance group and ADP ≥30% as non-resistance group. Logistic regression analysis was used to study the risk factors for the development of clopidogrel resistance. Results Among 202 patients with ischemic stroke, 87 were in the resistant group and 115 in the non-resistant group. The proportion of patients with clopidogrel resistance combined with diabetes and the level of white blood cell count were higher than that in the non-resistant group, and the differences were statistically significant (P<0.05).The proportion of patients with clopidogrel resistance in the CYP2C19 intermediate metabolism group was significantly higher than that in the fast metabolism group, and the rate of platelet inhibition was also significantly lower than that in the fast metabolism group, all with statistically significant differences (P<0.05). Conclusion Combined diabetes mellitus, high white blood cell count levels and CYP2C19 mid-metabolic phenotype are independent risk factors for the development of clopidogrel resistance in patients with ischemic stroke.
