Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis.

Abstract

OBJECTIVE:

To evaluate the interaction effect of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the efficacy and safety of dual/single antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) by the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial.

METHODS:

Patients with both MRI analysis and Lp-PLA2 testing results were included in the current subanalysis. The interaction of Lp-PLA2 activity with the effects of dual and single antiplatelet therapy were analyzed through Cox proportional hazards regressions model.

RESULTS:

Among the 797 patients, the mean age was 63.1 ± 10.8 years, 518 (65%) were men, 356 (44.7%) had ICAS, and 441 (55.3%) did not. There were significantly more patients with elevated Lp-PLA2 activity in the ICAS group than in the non-ICAS group (43.8% vs 35.4%, p = 0.02). There was significant interaction between Lp-PLA2 activity levels and the 2 antiplatelet therapies for prevention of stroke recurrences and combined vascular events even after adjustment for confounding factors exclusively for patients with ICAS (p = 0.017, 0.017, respectively), but not for those without (p = 0.332, 0.674, respectively). Compared with aspirin alone, dual antiplatelet therapy significantly reduced the risk of stroke recurrences and combined vascular events (adjusted hazard ratio 0.33 [0.12-0.89], p = 0.028; 0.33 [0.12-0.89], p = 0.028, respectively) for patients with ICAS and nonelevated Lp-PLA2 activity.

CONCLUSIONS:

Presence of both ICAS and nonelevated Lp-PLA2 activity may predict better response to dual antiplatelet therapy in prevention of recurrent strokes and combined vascular events for patients with minor stroke or high-risk TIA.

CLINICALTRIALSGOV IDENTIFIER:

NCT00979589.

• Authors: Ming Yang, Anxin Wang, Jiejie Li, Xingquan Zhao, Liping Liu, Xia Meng, Jing Jing, Nan Zhang, S Claiborne Johnston, Yilong Wang, Yongjun Wang
• Journal: Neurology (Neurology) Vol. 94 Issue 2 Pg. e181-e189 (01 14 2020) ISSN: 1526-632X [Electronic] United States
• PMID: 31822574 (Publication Type: Journal Article)
• Copyright: © 2019 American Academy of Neurology.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• 1-Alkyl-2-acetylglycerophosphocholine Esterase
• PLA2G7 protein, human
• Aspirin

Topics

• 1-Alkyl-2-acetylglycerophosphocholine Esterase (metabolism)
• Aged
• Aspirin (therapeutic use)
• Cerebrovascular Disorders (drug therapy, metabolism)
• Clopidogrel (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Recurrence
• Stroke (metabolism, prevention & control)