Comparison Of Three Clopidogrel Regimens In Patients With Cerebral Infarction And High Risk Of Gastrointestinal Bleeding

Objective:Comparative efficacy and safety of clopidogrel 50 mg,clopidogrel 50mg+proton pump inhibitors(PPI)and clopidogrel 75mg+PPI for secondary prevention of ischemic stroke patients with high risk of gastrointestinal bleeding by retrospective study and prospective cohort study.And provide evidence for such patients' treatment in clinical work.Methods:Retrospective study: Search for patients with ischemic stroke in guangzhou Red Cross hospital from April 2013 to April 2017.A total of 208 patients were enrolled in the study according to the inclusion criteria and exclusion criteria.They were divided into three groups according to the Clopidogrel regimen for secondary prevention(12 patients for clopidogrel 50 mg,27 for clopidogrel 50mg+PPI and 169 for clopidogrel 75 mg+PPI).The efficacy and safety were compared among the three groups.Prospective cohort study: All patients is from the department of neurology in guangzhou Red Cross hospital between January 2018 and January 2019 with a diagnosed of ischemic stroke.They were selected according to the inclusion criteria and exclusion criteria and had a 90-day follow-up.Finally,a total of 72 cases of patients were included in the study.They were divided into three groups according to the Clopidogrel regimen for secondary prevention(8 patients for clopidogrel 50 mg,15 for clopidogrel 50mg+PPI and 49 for clopidogrel 75 mg+PPI),of which 25 cases had a thromboelastogram examination(5patients for clopidogrel 50 mg,7 for clopidogrel 50mg+PPI and 13 for clopidogrel75mg+PPI).The efficacy,safety and the Average platelet aggregation rate were compared among the three groups.Results:Retrospective study: There were no significant differences in the incidence of bleeding events among the three groups after treatment(P=0.78).The incidence of ischemic events in the clopidogrel 75mg+PPI group was lower than that in the other two groups(P=0.00),and there were no significant differences in the incidence of ischemic events between the othertwo groups(P=0.53).Prospective cohort study: The TEG platelet mapping showed that the drug resistance rate of the clopidogrel 75mg+PPI group was lower than that of the other two groups(P=0.03),and the platelet inhibition rate was higher than that of the other two groups(P=0.00).There were no significant differences in the drug resistance rate and platelet inhibition rate of the other two groups.There were no significant differences in mRS score,NIHSS score,between the three groups before and after treatment.There were no significant differences in the incidence of ischemic events and bleeding events among the three groups.Conclusion:Ischemic stroke patients with high risk of gastrointestinal bleeding should be treated with PPI instead of reducing the dose of clopidogrel.