Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?

Zhang, Qian; Wang, Yuan; Song, Haiqing; Hou, Chengbei; Cao, Qingyu; Dong, Kai; Huang, Xiaoqin; Feng, Wuwei; Ovbiagele, Bruce; Wang, Moli; Ji, Xunming

doi:10.1016/j.jns.2016.12.025

Cited by 14 publications

(11 citation statements)

References 17 publications

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“…There were a total of 3843 ischemic stroke patients in the SRICHS in 2009. We included 2740 patients 63.9 ± 12.5 62.7 2650 Taiwan 0.0 Zhang [ 25 ] 2017 Retrospective cohort study We retrospectively reviewed the prospectively maintained stroke registry of a single medical center (Xuanwu Hospital) comprising 1910 non-cardiogenic ischemic stroke patients consecutively discharged from January 2013 to October 2014 58.68 ± 11.60 95.4 1792 China 1.0 Total 18 studies 987,074 …”

Section: Resultsmentioning

confidence: 99%

“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

Liu

et al. 2019

J Neurol

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Background Ischemic stroke (IS) is a common cause of death from vascular diseases. Studies have found that smoking increases the risk of ischemic stroke, but the association of smoking with the outcome of IS remains unclear. This metaanalysis aims to investigate the effect of smoking on the prognosis of IS. Methods We searched four electronic databases including PubMed, EMBASE, Cochrane library and Web of science for papers, published before January 2019. In this meta-analysis, Review Manager 5.3 software was used to calculate for the pooled estimate effect, as well as the inverse-variance method for pooled mean difference (MD) and odds ratio (OR) of incidence in two groups of population. Results A total of 14,789 citations were identified during the literature search, 21 studies were included in the meta-analyses after screening. The full-adjusted OR of poor prognostic outcome in smoking and nonsmoking patients with stroke was pooled as 0.96 (95% CI 0.77-1.21), suggested that smoking or not has no impact on prognosis of IS. The pooled MD of onset age between smoking and nonsmoking IS patients was − 10.05 (− 12.91, − 7.19), indicated that smoking causes first onset of IS to occur 10 years earlier. Conclusions This meta-analysis showed that smoking was not a protective factor for poor prognosis of IS. Smoking patients with IS are 10 years younger than nonsmoking patients at time of the first onset of stroke.

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Section: Resultsmentioning

confidence: 99%

“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

Liu

et al. 2019

J Neurol

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“…Similarly, Maruyama et al [ 46 ] demonstrated that smokers achieve significantly lower platelet reactivity values (128 vs. 167 PRU, p = 0.002) than nonsmokers and, additionally, the incidence of clopidogrel resistance is significantly lower in smokers (12.9% vs. 25.9%; p = 0.033). Zhang et al [ 47 ] concluded that the antiplatelet effect of clopidogrel in ischemic stroke patients is much better in smokers and showed a statistical trend for a reduced risk of recurrent vascular events with clopidorel than with aspirin [ 47 ]. The explanation of the above dependencies is believed to be the activation of the cytochrome P450 complex by nicotine, which may result in a more efficient metabolization of clopidogrel by the liver, leading to increased platelet inhibition [ 46 ].…”

Section: Factors Influencing Clopidogrel Resistancementioning

confidence: 99%

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review

Wiśniewski

Filipska

2020

IJMS

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Clopidogrel is increasingly being used for the secondary prevention of ischemic stroke according to the updated guidelines on acute stroke management. Failure to achieve a drug response is referred to as clopidogrel resistance. Similarly, a higher activation of platelets during clopidogrel therapy—high on-treatment platelet reactivity—is equivalent to a reduced effectiveness of a therapy. Clopidogrel resistance is considered to be a common and multifactorial phenomenon that significantly limits the efficacy of antiplatelet agents. The aim of the current study is to review the latest literature data to identify the prevalance and predictors of clopidogrel high on-treatment platelet reactivity among stroke subjects and to establish the potential impact on clinical outcomes and prognosis. Clinical databases were searched by two independent researchers to select relevant papers on the topic, including all types of articles. Several important predictors contributing to clopidogrel resistance were identified, including genetic polymorphisms, the concomitant use of other drugs, or vascular risk factors, in particular nonsmoking and diabetes. Clopidogrel high on-treatment platelet reactivity has a negative impact on the clinical course of stroke, worsens the early- and long-term prognoses, and increases the risk of recurrent vascular events. Platelet function testing should be considered in selected stroke individuals, especially those predisposed to clopidogrel resistance, for whom an improvement in the efficacy of antiplatelet therapy is essential. This particular group may become the greatest beneficiaries of the modification of existing therapy based on platelet function monitoring.

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“…ischemic stroke is one of the most frequently occurring conditions among older populations, accounting for a large proportion of the morbidity and mortality rates worldwide (1,2). Smoking habits, hypertension and diabetes have all been listed as risk factors of ischemic stroke (3,4). ischemic stroke occurs following a blockage in an artery leading to the brain; thus, an insufficient supply of oxygen and glucose reaches the brain that is required for cellular energy, which culminates in irreparable damage (5,6).…”

Section: Introductionmentioning

confidence: 99%

Protective effect of microRNA‑340‑5p against oxygen‑glucose deprivation/reperfusion in PC12 cells through targeting neuronal differentiation 4

Wang

Liu

2020

Mol Med Rep

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The expression levels of microrna (mir)-340-5p are reportedly decreased in the peripheral blood during acute ischemic stroke; however, the direct effect and mechanism of action of mir-340-5p in ischemic stroke remains largely unknown. The present study aimed to investigate the effects of mir-340-5p, and its mechanism of action, on Pc12 cells following oxygen-glucose deprivation/reperfusion (oGd/r) induction. oGd/r-induced Pc12 cells served as the cellular model and subsequently, mrna expression levels of mir-340-5p and neuronal differentiation 4 (neurod4) were analyzed using reverse transcription-quantitative Pcr. Tumor necrosis factor-α, interleukin (il)-1β and il-6 expression levels were detected using ELISA kits, and flow cytometry was used to determine the rate of cellular apoptosis. in addition, a nitric oxide (no) synthase activity assay kit was used to detect no levels and a nadPH assay kit was used to measure nadPH levels. Western blotting was also performed to analyze protein expression levels of bax, bcl-2, cleaved caspase 3 and phosphorylated endothelial noS (enoS), and the target gene of mir-340-5p was predicted using TargetScan software and verified using a dual-luciferase reporter assay. The expression levels of mir-340-5p were decreased in Pc12 cells following oGd/r induction and Neurod4 was identified as a target gene of miR-340-5p. In addition, miR-340-5p overexpression reduced inflammation, apoptotic rate, no production and nadPH levels, in addition to increasing enoS expression in Pc12 cells following oGd/r induction. notably, the overexpression of neurod4 reversed the aforementioned effects of mir-340-5p on Pc12 cells following OGD/R induction. In conclusion, the findings of the present study suggested that mir-340-5p may protect Pc12 cells against oGd/r through targeting neurod4, which could provide important implications for the treatment of ischemia-reperfusion injury based on mir-340-5p expression levels in vivo.

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Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?

Cited by 14 publications

References 17 publications

“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

“Smoking paradox” is not true in patients with ischemic stroke: a systematic review and meta-analysis

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review

Protective effect of microRNA‑340‑5p against oxygen‑glucose deprivation/reperfusion in PC12 cells through targeting neuronal differentiation 4

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