Baseline platelet parameters for predicting early platelet response and clinical outcomes in patients with non-cardioembolic ischemic stroke treated with clopidogrel

// Wenxian Li 1, * , Xiaomei Xie 1, * , Di Wei 5, * , Shijun Zhang 2 , Yuanling Wu 1 , Xuejun Fu 3 , Zhen Jing 1 , Weibiao Lu 1 , Xinqiang Lai 4, # and Li’an Huang 1, # 1 Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, 510632, P.R. China 2 Department of Neurology, People’s Hospital of Zengcheng District, Guangzhou, Guangdong, 510180, P.R. China 3 Department of Neurology, People’s Hospital, Second Clinical College, Jinan University, Shenzhen, 518020, P.R. China 4 Analysis and Testing Center, Jinan University, Guangzhou, Guangdong, 510632, P.R. China 5 Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, 710032, P.R. China * These authors contributed equally to this work and share first authorship # These authors contributed equally to this study and share corresponding authorship Correspondence to: Li’an Huang, email: huanglian1306@126.com Xinqiang Lai, email: xinqianglai@126.com Keywords: mean platelet volume, platelet count, clopidogrel resistance, non-cardioembolic ischemic stroke, platelet response Received: June 11, 2017      Accepted: September 21, 2017      Published: October 07, 2017 ABSTRACT Purpose: The present study investigated whether routine baseline platelet parameters(BPPs) detected before clopidogrel therapy in acute non-cardioembolic ischemic stroke(NCIS) could predict early platelet response and future clinical outcomes. Results: The CYP2C19 polymorphisms constituted independent risk factors for LCR. The number of female patients, the incidence of diabetes mellitus (DM), the level of low-density lipoprotein(LDL) cholesterol, and the neutrophil-to-lymphocyte ratio(NLR) were significantly high in the clinical clopidogrel resistance (CCR) group. However, none of the BPPs had a significant association with laboratory clopidogrel resistance (LCR) or discriminated with the cut-off values regarding LCR or CCR. The patients were divided into two groups according to the average mean platelet volume(MPV) or platelet count(PC). We found that the HbA1c level, the number of female patients, and the CCR were higher in the groups with elevated MPV (≥ 10.6fL) and PC (≥ 235 × 10 9 /L); the LCR, the NIHSS score at discharge, and elevated MPV and PC were risk predictors for CCR. Materials and Methods: This study included 196 patients with acute NCIS who underwent routine blood tests upon admission, were treated with clopidogrel, and were followed up for 6 months. Early platelet response was assessed and the CYP2C19 genetic variants were screened for. All participants were categorized into either laboratory clopidogrel resistance(LCR) or clinical clopidogrel resistance (CCR) groups. Conclusions: Elevated baseline MPV and PC before clopidogrel therapy, as well as CYP2C19 gene variants, should be included in a risk algorithm for NCIS. Furthermore, other nongenetic clinical risk factors should be assessed for optimal prediction of the risk for thrombotic events because of individual variability in platelet response to clopidogrel.