Abstract Details

Title A Clinical Prediction Tool for Clopidogrel Non-responsiveness in Ischemic Stroke Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S44 - Evidence-based Stroke Interventions and Prognostic Tools (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective

To develop and evaluate a clinically accessible scoring tool, CLEAR (Clopidogrel Response Evaluation and Risk) Score, for predicting clopidogrel non-responsiveness using non-genetic, routinely collected clinical and laboratory data in patients with ischemic stroke.

Background

Clopidogrel non-responsiveness is an important but under-recognized cause of recurrent ischemic stroke. P2Y12 platelet function testing is not widely available, and CYP2C19 genetic testing remains underutilized due to cost. A simple, clinically driven prediction score is needed to identify potential clopidogrel non-responders in routine practice.

Design/Methods We retrospectively reviewed 61 ischemic stroke patients who underwent P2Y12 platelet function testing. Non-responsiveness was defined as a P2Y12 reaction unit (PRU) ≥195. CLEAR Score was developed by assigning weighted binary points to six clinical variables associated with non-responsiveness: diabetes (A1c ≥7%) 2 points, chronic kidney disease (GFR <60 mL/min) 2 points, proton pump inhibitor (PPI) use 3 points, mean platelet volume (MPV ≥10.5 fL) 2 points, non-smoker status 1 point, and prior ischemic stroke 1 point. Patients were classified as responders or non-responders, and scores were compared using Mann–Whitney U tests. ROC analysis was performed to assess predictive accuracy.

Results Among 61 patients (15 non-responders, 46 responders), the median CLEAR Score was significantly higher in non-responders (6.0) compared to responders (3.0). Mean component scores for PPI use (2.4 vs 0.3, p<0.01) and CKD (1.1 vs 0.4, p<0.02) were highest among non-responders. MPV was significantly elevated in non-responders (median 10.5 fL vs 9.4 fL, p=0.0002). Area under the ROC curve (AUC) for CLEAR Score was 0.71, demonstrating good discriminative ability.

Conclusions

The CLEAR Score is a practical, clinically relevant tool to predict clopidogrel non-responsiveness in ischemic stroke patients. It uses routine clinical and laboratory data to help identify patients who may benefit from alternative antiplatelet therapy, such as ticagrelor. The homogeneity of the study population limits generalizability. Future validation in diverse populations is necessary.

Authors/Disclosures
Taqua Tabassum, MD PRESENTER	Dr. Tabassum has nothing to disclose.
Jake Plagenz, MD	Jake Plagenz, MD has nothing to disclose.
Amy J. Lin, MD (Sanford Health)	Dr. Lin has nothing to disclose.
Whitney Carriveau	Mrs. Carriveau has nothing to disclose.
Suhas Bajgur, MD	Dr. Bajgur has nothing to disclose.

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