Ischemic Stroke Risk Increased With Higher Platelet Reactivity Post-DES Implantation

Patients who received clopidogrel and had high platelet reactivity following coronary drug-eluting stent (DES) implantation were at an increased risk for ischemic stroke, according to an analysis of the Assessment of Dual Antiplatelet Therapy With Drug Eluting Stents (ADAPT-DES; ClinicalTrials.gov Identifier: NCT00638794) study published in JACC Cardiovascular Interventions.

The prospective multicenter ADAPT-DES study registry was used to obtain data on 8582 patients who were treated successfully with DES. Patients in the study were maintained on aspirin and clopidogrel for 2 years and 1 year, respectively. For this analysis, researchers evaluated the association between post-DES implantation P2Y₁₂ reaction units (PRU) and ischemic stroke risk with adjustments made for CHA₂DS₂-VASc score in a subsequent analysis.

During the 2-year follow-up, approximately 0.8% of patients who underwent successful DES implantation experienced an ischemic stroke. The rates of ischemic stroke increased significantly once patients moved from the lowest PRU quintile (more P2Y12-receptor inhibition; 2-year rate of 0.51%) to the highest PRU quintile (less P2Y12-receptor inhibition; 2-year rate of 1.34%; adjusted P =.04).

In patients with a high CHA₂DS₂-VASc score, the association between higher PRU and increased ischemic stroke risk persisted (P_interaction =.30). Additionally, there was an association between elevated higher PRU and ischemic stroke in patients who were taking or not taking an anticoagulant medication at hospital discharge (P_interaction =.99).

The researchers found PRU >208 was an independent predictor for ischemic stroke risk at 2 years (adjusted hazard ratio [HR], 1.81; 95% CI, 1.08-3.04; P =.03). Patients with an ischemic stroke were also at an increased risk for cardiovascular mortality (adjusted HR, 4.57; 95% CI, 1.86-11.24; P =.0009) and all-cause mortality (adjusted HR, 4.16; 95% CI, 1.95-8.87; P <.0001) at 2-year follow-up.

Findings from the study are considered hypothesis-generating only because of the post-hoc analysis design.

The researchers added that the risk for ischemic stroke in patients undergoing DES implantation may be mitigated by achieving optimal platelet inhibition.

Disclosures: Many of the researchers report financial relationships with pharmaceutical and medical device companies, including Medtronic, Boston Scientific, Edwards Lifesciences, Abbott Vascular, Daiichi Sankyo, and others.

Reference

Giustino G, Redfors B, Kirtane AJ, et al. Platelet reactivity and risk of ischemic stroke after coronary drug-eluting stent implantation: from the ADAPT-DES study [published online June 8, 2018]. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2018.01.263