Abstract | OBJECTIVE: Whether aspirin platelet reactivity affects platelet function and clinical outcomes with different antiplatelet therapies in patients with mild stroke or transient ischemic attack (TIA) remains unclear. We conducted a subgroup analysis of the PRINCE trial. MATERIALS AND METHODS: Patients with mild stroke or TIA were randomized into aspirin+ticagrelor, or aspirin+clopidogrel groups; aspirin reaction units (ARU) were measured at the baseline and after 7 ± 2 days to assess response to treatment. High on-treatment platelet reactivity (HPR) was defined as ≥550 ARU (poor response to aspirin). The platelet functions of ticagrelor and clopidogrel were measured using the VerifyNow P2Y12 assay for P2Y12 reaction units (PRU); HPR to P2Y12 was defined as >208 PRU (poor response to P2Y12). Clinical outcomes included stroke and clinical vascular and bleeding events after 90 days. RESULTS: Among 628 enrolled patients, 69 (11%) were poor aspirin responders. After 7 ± 2 days, the proportion of poor P2Y12 responders for ticagrelor versus clopidogrel significantly reduced in poor (2.6% versus 27.4%) and good (14.3% versus 29.4%) aspirin responders. There were significant interactions between treatment groups, and between treatment groups and aspirin platelet reactivity for poor P2Y12 responders (P = 0.01). After 90 ± 7 days, there were no significant interactions between treatment groups and aspirin platelet reactivity for new stroke risk (good aspirin responders: 5.5% versus 8.8%, hazard ratio [HR]: 0.61; 95% confidence interval [CI], 0.32 to 1.16; P = 0.13; poor aspirin responders: 8.6% versus 8.8%, HR: 0.97, 95% CI: 0.20-4.81; P = 0.97; P for interaction = 0.60). Major bleeding was less frequent in poor than good aspirin responders ( ticagrelor/ aspirin: 0.4%/0%; clopidogrel/ aspirin: 1.4%/0%). CONCLUSIONS:
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Authors | Yanjie Xu, Weiqi Chen, Lingling Jiang, Yicong Wang, Xingquan Zhao, Liping Liu, Dongxiao Yao, Lei Guo, Yongjun Wang, Yuesong Pan, Yilong Wang |
Journal | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
(J Stroke Cerebrovasc Dis)
Vol. 31
Issue 9
Pg. 106683
(Sep 2022)
ISSN: 1532-8511 [Electronic] United States |
PMID | 35914511
(Publication Type: Journal Article, Randomized Controlled Trial)
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Copyright | Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
- Ticagrelor
- Aspirin
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Topics |
- Aspirin
(adverse effects)
- Clopidogrel
(adverse effects)
- Drug Therapy, Combination
- Humans
- Ischemic Attack, Transient
(chemically induced, diagnosis, drug therapy)
- Platelet Aggregation Inhibitors
(adverse effects)
- Stroke
(chemically induced, diagnosis, drug therapy)
- Ticagrelor
(adverse effects)
- Treatment Outcome
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