Clopidogrel Resistance

[Casper438]

my dad had a mild stroke 7 weeks ago and told he would make a 99% recovery, only his speech was affected. He is now in hospital again with a second stroke which is considerably worse and right arm now affected, despite taking his clopidogrel, statin and blood pressure meds as prescribed. He had 3 weeks of aspirin after first and has just been prescribed all same meds again! His BP was fine, cholesterol fine, carotid artery’s scan didn’t show anything significant and 72hr heart trace showed no AF. I’m really worried he has another as they don’t know where the clots are coming from and I’ve questioned if he could be clopidogrel / aspirin resistant as the meds didn’t work in preventing another in such quick succession. Any advice would be greatly appreciated. Thank you

[john-boy-92]

Clopidogrel is metabolised by a gene, but unfortunately a third of the population have a mutation in that gene that means clopidogrel is less effective. Stroke survivors are initially prescribed clopidogrel and aspirin before permanent medication. As he was prescribed clopidogrel, I guess that the stroke was a bleed, not a clot. Bristol University recently published a paper for a NICE study, that indicates it may be financially viable to assess patients for that mutation. The paper may not be on the research web site yet, as part of the text was due to be redacted. I assume that the stroke was not caused by a clot as you haven’t mentioned thrombolysis and an anticoagulant.

I'm a stroke survivor on Pradaxa, and I'm a lived experience participant in stroke and AF studies.

[Casper438 in reply to john-boy-92]

thank you so much for taking the time to reply, unfortunately we were informed the end of last week that it was never strokes and in fact a brain tumour. All devastated but now going down a very different path. Keep we’ll yourself. Thank you

[john-boy-92 in reply to Casper438]

I'm sorry to hear that. It's important that you take care of yourself too. These paths are never easy.

[Holiday12345 in reply to john-boy-92]

is Clopidrogrel not an antiplatlet medication. I was given it after mini stroke to prevent another clot. However it’s causing too much bleeding now I’ve been taken off it for a short while. Does anyone know if there are any studies into smaller dose Clopidrogrel as it’s a one size fits all so me slight 8stone get same dose as big muscular 20stone person. I know it’s only one pill 75mg makers haven’t done any research into cutting it up to swallow etc but just wondering if there is anything at all out there re research into smaller doses?

[john-boy-92 in reply to Holiday12345]

Clopidogrel is an antiplatelet given when a stroke or TIA is caused by a clot not related to atrial fibrillation. The NHS list the dose as 75mg. You would need to ask a cardiac specialist if it is appropriate to reduce the size opf the dose. NICE or NHRA may have some information.

[Raisinbread]

I have very similar test outcomes and medication after my stroke. I too would like to find what part of me produced an older stroke scar and the latest one. I will be asking for more monitoring of my heart for atrial fibrillation .

[Chinkoflight]

Hi, I had a severe stroke a year ago on holiday, pessimistic outcome but, I had great fast treatment, thrombolysed, and was able to walk out of hospital a few days later. Post stroke was Clopidogrel and Atorvastatin plus follow up ECG holsters. 2 X 24 hr and 1x7day. Both have poor largely unreadable results. The stroke was paroxysmal, ie no obvious cause. The only issue found was bradycardia with ectopic beats. I'm 71.I was stressed for some time. I researched and knew Birmingham Trusts had abandoned Holters and started fitting ECG implants LINQ devices to constantly monitor the heart through a special linked telephone type device to look for arythmia etc. Very sophisticated. I pestered locally but bought a smart watch and a Kardia monitoring ECG on recommendation ofy GP. I had some short high HR readings and my GP made approaches again to the stroke team. As time moved on,NICE gave national advice saying LINQ devices should be fitted and in February this year I was called in.

After 2 months or so of getting readings to find out through AI I believe, what is normal for me, 3 weeks ago I was called by the hospital cardio physiologist to say they had been altered to a short AF unusual event, possibly atrial flutter. What had I been doing etc at the time. I was not doing anything out of the ordinary, I had been occasionally dizzy around that time which is unusual, but I was unaware of the event.

A call from the Consultant next and an immediate switch away from Clopidogrel to an anticoagulant EDOXABAN, also subject to a new NICE/NHS initiative to get 600000 new people prescribed as a big preventative stroke strategy.

Hopefully this will help you go back to your GP or consultant for a better discussion.

[Casper438 in reply to Chinkoflight]

thank you for the reply, much appreciated

[Chinkoflight in reply to Casper438]

Just seen your update, I'm so sorry to hear the more recent diagnosis, I hope you get the best care.

[john-boy-92 in reply to Chinkoflight]

Interesting comment about 600,000 people being put on Edoxaban (an anticoagulant) to prevent stroke, as there isn't a national policy on screening for AF. My understanding is that clopidogrel is prescribed if the clot is not related to AF, yet it appears you had / have AF. It's known that a third of people do not metabolise clopidogrel well, and an even greater percentage of south asians and afro-carribeans. Until genotype testing is in place, it could be that some people are being moved from clopidogrel as a precaution.

[Chinkoflight in reply to john-boy-92]

nice.org.uk/guidance/dg41/c... a point well made about Clopidogrel resistance but it was clearly working in my case! The above link is the 2020 guidance on LINQ implants (ECG) for detection of suspected AF after a stroke. It is due to be reviewed this year and hopefully my data will add to the pressure to maintain or extend this policy.

Once AF is detected the outcome is to change to an anticoagulant and other NICE guidance is as I said above re EDOXABAN.