Resistance to Antiplatelet Therapy Is Associated With Symptoms of Cerebral Ischemia in Carotid Artery Disease

Stephen T E Ball, Rachael Taylor, Charles N McCollum, Stephen T E Ball, Rachael Taylor, Charles N McCollum

Abstract

Background: Platelet inhibitory therapy is prescribed to prevent arterial thromboembolism in patients with atherosclerotic disease. Although taken by millions of people, around 30% are resistant to the treatment they are being prescribed.

Aims: To determine whether symptoms of cerebral ischemia, or pre-operative cerebral emboli, in patients admitted for a carotid endarterectomy were associated with resistance to aspirin or clopidogrel.

Methods: Venous blood from 133 patients immediately before carotid endarterectomy (CEA) was analyzed for resistance to aspirin and clopidogrel by multiplate impedance aggregometry. The number of emboli/hour entering the ipsilateral middle cerebral artery was counted by transcranial Doppler (TCD) on the day before surgery in 33 of these patients.

Results: Resistance was found in 21 (26.3%) of 100 patients taking aspirin and 14 (42%) of 33 taking clopidogrel. Mean (sd) residual platelet aggregation was significantly higher at 41.9(32) Au in patients who had suffered recent symptoms of cerebral ischemia compared with 30.8(16) Au in asymptomatic patients (p = 0.012). Residual platelet aggregation also correlated significantly with the number of emboli/hour counted by TCD in the ipsilateral middle cerebral artery (r = 0.45, p = 0.009).

Conclusion: Antiplatelet resistance was associated with the frequency of cerebral emboli and recent symptoms of cerebral ischemia in patients with carotid disease. Definitive clinical studies are needed to explore whether testing for antiplatelet resistance should be undertaken routinely in patients starting platelet inhibitory therapy for cardiovascular disease.

Keywords: Antiplatelet resistance; aggregation; carotid artery disease; carotid endarterectomy; cerebral emboli; cerebral ischemia.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Mean (SD) residual platelet aggregation was significantly higher at 41.9(32)Au in the 102 CEA. Patients with symptoms of cerebral ischemia compared with 30.8(16)Au in the 31 asymptomatic patients (p = 0.012).
Figure 2.
Figure 2.
There was a significant correlation of r = 0.45 (p = 0.009) between residual platelet aggregation and the number of cerebral emboli in the ipsilateral middle cerebral artery detected by TCD before CEA in 33, patients.

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