Predicting clopidogrel resistance in acute ischemic stroke patients: key clinical insights and a novel diagnostic nomogram
Abstract
BACKGROUND: Clopidogrel plays an important role in the treatment of acute ischemic strokes (AIS) through antiplatelet activity. However, some patients have clopidogrel resistance (CR), which could lead to stroke recurrence and bleeding. This study aimed to explore associated factors of CR and establish a diagnostic nomogram for predicting the probability of CR in AIS patients. METHODS: This retrospective study involved 692 AIS patients from the Second Affiliated Hospital of Guangzhou Medical University, treated with clopidogrel (75 mg/day for 5 ± 2 days) after admission. Platelet reactivity was evaluated using thromboelastography to measure the ADP-induced platelet inhibition ratio (ADP-PIR). Patients were classified into CR (ADP-PIR < 30%) and non-clopidogrel resistance (NCR) groups. Group comparison, followed by least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression, was used to identify key predictors of CR. A diagnostic nomogram was developed and its performance was validated using bootstrap resampling. RESULTS: 16.76% of 692 patients experienced CR after AIS. Beta blocker use (OR: 0.47, 95% CI: 0.22-1.03, P = 0.058) and apolipoprotein A1 (OR: 0.17, 95% CI: 0.07-0.46, P < 0.001) were identified as protective factors, while unstable carotid plaque (OR: 10.65, 95% CI: 4.18-27.13, P < 0.001), high apolipoprotein B levels (OR: 2.35, 95% CI: 1.23-4.51, P = 0.01), and proton pump inhibitors use (OR: 2.09, 95% CI: 1.32-3.31, P =…
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