Changes of Platelet Activation and Clinical Outcome in Acute Atherosclerotic Cerebral Infarction Treated with Clopidogrel Loading Dose (300 mg)

ABSTRACT

BACKGROUND: Platelet activation has an important role in progression of atherosclerotic vascular events. To know the beneficial effects of clopidogrel loading dose about changes of platelet activation and clinical outcome in acute stage of atherosclerotic infarction, we performed a prospective randominized study. METHODS: Patients with large artery atherosclerotic infarction were randomized to clopidogrel loading dose (n=24) or intravenous heparin with low dose aspirin (n=28) during 7 days. We measured the surface expression of CD63 on platelets and the platelet aggregability for 7 days. The National Institute of Health Stroke Scale (NIHSS) score was recorded at 24 hours, 72 hours, and 7 days after stroke. Three-month outcome was recorded by the modified Barthel index (BI). RESULTS: As compared with intravenous heparin, the loading dose of clopidogrel was associated with significant reduction of the surface expression of CD63 on platelets, platelet aggregability, and NIHSS score. The clopidogrel loading dose-treated patients were more likely to have a very favorable outcome on BI index at 3 months. CONCLUSIONS: Our results showed that the clopidogrel loading dose has beneficial effects of clinical outcome of acute stage of large artery atherosclerotic infarction may be mediated by the platelet hyperactivity in these patients. Thus, this loading dose trial deserves further evaluation in clinical trial for treatment in large artery atherosclerotic infarction.