Title:Thromboelastographic and Gene Polymorphism Bimodality Detection for
Dual Antiplatelet Aggregation Therapy in Individuals with
Clopidogrel-resistant Symptomatic Intracranial Artery Stenosis
Volume: 27
Issue: 3
Author(s): Longlong Liu*, Yan Li and Ying Li
Affiliation:
- Department of Emergency, Binzhou People's Hospital, Binzhou, Shandong, 256600, China
Keywords:
Intracranial large artery atherosclerotic stenosis, ischemic stroke, clopidogrel resistance, thromboelastography, clopidogrel gene polymorphism testing, ticagrelor antiplatelet aggregation therapy.
Abstract:
Background: Recent research indicates that clopidogrel resistance is connected with a
patient's future ischemia risk, hence increasing the likelihood of recurrent ischemic cerebrovascular
disease. Thromboelastographic and clopidogrel gene polymorphism testing can be used to
see how a person responds to antiplatelet therapy and change the treatment plan accordingly.
This may be a good way to make antiplatelet aggregation therapy more effective and safer.
Objective: The objective of this study was to investigate the efficacy of dual antiplatelet aggregation
therapy in patients with symptomatic intracranial large artery stenosis being resistant to
clopidogrel tablets. The thromboelastographic and gene polymorphism bimodality detection
techniques were used to analyze the clopidogrel resistance influencing factors.
Methods: 89 patients with symptomatic intracranial large arterial stenosis who were admitted to
our hospital from February 2021 to February 2022 were selected, classified as large artery atherosclerotic
type by TOAST, and confirmed as having severe intracranial large arterial stenosis (70
% to 99 %) by magnetic resonance angiography (MRA), computed tomographic angiography
(CTA), and digital subtraction angiography (DSA). All patients were treated with dual antiplatelet
therapy with aspirin and clopidogrel, and thromboelastography and clopidogrel gene polymorphism
were monitored 1 week later.
Results: 44 of 89 patients were clopidogrel-resistant. Among 44 patients, 20 were ticagrelorresistant
and 24 were cilostazol-resistant. Clopidogrel had a resistance rate of 49.4%. The recurrence
of ischemic cerebrovascular disease in the three groups was statistically significant (P<0.05)
after 3 months of follow-up treatment, but bleeding (intracranial, gastrointestinal, respiratory, urinary,
and mucocutaneous) and dyspnea were not. The clopidogrel-resistant group had a higher
number of females, as well as higher levels of hypertension, diabetes, and platelet count than the
sensitive group (P<0.05), but there was no significant difference in age, smoking, alcohol consumption,
previous stroke, glycosylated haemoglobin, creatinine, or low-density cholesterol.
Conclusion: Using thromboelastographic and gene polymorphism bimodality detection, we found
switching to ticagrelor antiplatelet aggregation therapy as better than switching to cilostazol in patients
with symptomatic intracranial large artery stenosis being resistant to clopidogrel tablets. The
results may be biased due to the study being a single-centre study and having a limited sample size.
