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Clinical Significance of Acute and Serial Platelet Function Testing in Acute Ischemic Stroke.

ABSTRACT: We sought to investigate the clinical implications of platelet reactivity to aspirin and the variability in the platelet reactivity to aspirin during acute periods for the risk of vascular events in patients with acute ischemic stroke.This was a single-center, prospective, observational study. The aspirin reaction unit was blindly measured at the following two times: after 3 hours of aspirin loading and on the fifth day of aspirin administration. High on-aspirin platelet reactivity (HAPR) was defined as an aspirin reaction unit ?550 IU. The primary outcome measure was the 1-year composite of stroke, myocardial infarction, and vascular death. A total of 805 patients (aged 66±12 years, 61% male) were analyzed in this study. Ninety-nine of 805 (12.3%) patients and 78 of 558 (14.0%) patients had HAPR at the time of the fifth day of aspirin administration and after 3 hours of aspirin loading measurements, respectively. Patients with HAPR than normal on-aspirin platelet reactivity at the fifth day of aspirin administration measurement were more likely to have experienced 1-year vascular event. HAPR at the fifth day of aspirin administration measurement was independently associated with a greater risk of experiencing 1-year vascular event (hazard ratio, 1.84; 95% confidence interval, 1.07-3.19). Moreover, persistently HAPR substantially increased the risk of 1-year vascular events (hazard ratio, 3.11; 95% confidence interval, 1.23-7.86).These results suggest that HAPR during the acute stage of ischemic stroke increases the risk of subsequent vascular events and that serial aspirin reaction unit measurements may identify patients with acute ischemic stroke who are at a higher risk for vascular events. Additional studies are warranted to determine the appropriate treatments for patients with acute ischemic stroke with HAPR.

SUBMITTER: Kim JT

PROVIDER: S-EPMC6015392 | biostudies-other | 2018 Jun

REPOSITORIES: biostudies-other

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Clinical Significance of Acute and Serial Platelet Function Testing in Acute Ischemic Stroke.

Kim Joon-Tae JT Choi Kang-Ho KH Park Man-Seok MS Lee Ji Sung JS Saver Jeffrey L JL Cho Ki-Hyun KH

Journal of the American Heart Association 20180601 11

<h4>Background</h4>We sought to investigate the clinical implications of platelet reactivity to aspirin and the variability in the platelet reactivity to aspirin during acute periods for the risk of vascular events in patients with acute ischemic stroke.<h4>Methods and results</h4>This was a single-center, prospective, observational study. The aspirin reaction unit was blindly measured at the following two times: after 3 hours of aspirin loading and on the fifth day of aspirin administration. Hi ...[more]

PMID: 29858358

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Project description:IntroductionIschemic stroke can occur due to disruption of blood and oxygen supply to brain tissue. White blood cells and platelets play an important role in the pathogenesis of ischemic stroke. Several studies have concluded that the lower the platelet count and the higher the number of white blood cells in ischemic stroke patients will result in a more severe stroke and had worsen prognosis. Platelet and white blood cells counts can be converted into Platelet-to-White Blood Cell Ratio (PWR) which is a comparison between the number of platelets and white blood cells, so the higher PWR will provide better clinical outcomes. Here, we examined correlation between PWR and clinical outcome in acute ischemic stroke using NIHSS tools.MethodThis research method was a retrospective analytic from 503 medical records of ischemic stroke patients from January 2015 to December 2017. Ischemic stroke divided into 2 groups: cardioembolic stroke and atherothrombotic stroke based on medical records. We calculated PWR and National Institute of Health Stroke Scale (NIHSS) for assessing clinical outcome. Statistical significance calculated with Spearman rank test, ANOVA, and multiple logistic regression.ResultsA total of 391 research subjects consisting of 213 females (54.5%) and 178 males (45.5%). The mean age of 57.14 years, and 82% subjects had hypertension as risk factor. Mean PWR of atherothrombotic stroke subjects were higher than cardioembolic stroke (33.02 vs 26.73) but had lower mean of NIHSS (5.81 vs 10.31) and had strong negative significant correlation between PWR and NIHSS (r = -0.9603; p < 0.001). From logistic regression, we found that PWR and platelet was statistically significance correlate with NIHSS (p < 0.05). The coefficient if PWR is the highest (absolute value) among other independent variables.It shows that PWR has positive effect on clinical outcome using NIHSS tools in acute ischemic stroke patients.ConclusionCardioembolic stroke had higher PWR compared with atherothrombotic stroke. PWR had a strong correlation with NIHSS. The higher PWR will provide higher NIHSS and PWR has positive effect on clinical outcome using NIHSS tools in acute ischemic stroke patients.

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Clinical Significance of Acute and Serial Platelet Function Testing in Acute Ischemic Stroke.

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Clinical Significance of Acute and Serial Platelet Function Testing in Acute Ischemic Stroke.

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