Abstract W P59: Safety and Efficacy of Acute Clopidogrel Load in Patients with Moderate and Severe Ischemic Strokes

Objective: To study the safety and efficacy of clopidogrel loading in patients with moderate and severe strokes. Background: The safety of clopidogrel loading has been extensively investigated in patients with minor strokes and transient ischemic attacks. Methods: AIS patients presenting consecutively to our center from 06/07/07-07/31/13 were screened. Clopidogrel loading was defined as at least 300 mg dose (with or without aspirin) given within 6 hours of admission. We compared outcomes in patients with baseline NIHSS >3 with and without clopidogrel loading. Results: Inclusion criteria were met for 1011 patients (43.6% females, 69.1% black, median age 63). Patients with clopidogrel loading had lower baseline NIHSS than patients not loaded (8 vs 9, p=0.005). The two groups had similar risk of hemorrhagic transformation (p=0.918) and symptomatic hemorrhage (p=0.599). Patients who were loaded had a lower rate of neuroworsening (defined as an increase in NIHSS score by 2 points within 24 hours, 38.9% vs 48.3%, p=0.031) and less in-hospital mortality (4.3% vs 13.4%, p=0.001) compared to those who were not loaded. The likelihood of having a poor functional outcome (defined as mRS > 2 on discharge) did not differ between the two groups after adjusting for NIHSS on admission (OR=0.71, 95% CI 0.4633-1.0906, p=0.118). Conclusion: Clopidogrel loading dose is safe and was associated with reduced rates of neuroworsening and mortality following AIS in patients with more than minor stroke. A prospective study of safety and efficacy at preventing stroke progression more than minor strokes is warranted.