Intravenous thrombolysis and platelet count

Gensicke, Henrik; Sultan, Abdulaziz S Al; Strbian, Daniel; Hametner, Christian; Zinkstok, Sanne M.; Moulin, Solène; Bill, Olivier; Zini, Andrea; Padjen, Višnja; Kägi, Georg; Pezzini, Alessandro; Seiffge, David J; Traenka, Christopher; Räty, Silja; Amiri, Hemasse; Zonneveld, Thomas P.; Lachenmeier, Romina; Polymeris, Alexandros; Roos, Yvo B.W.E.M.; Gumbinger, Christoph; Jovanović, Dejana; Curtze, Sami; Sibolt, Gerli; Vandelli, Laura; Ringleb, Peter A.; Leys, Didier; Cordonnier, Charlotte; Michel, Patrik; Lyrer, Philippe; Peters, Nils; Tatlısumak, Turgut; Nederkoorn, Paul J.; Engelter, Stefan T.

doi:10.1212/wnl.0000000000004982

Cited by 45 publications

(44 citation statements)

References 30 publications

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“…10,13 However, in patients treated with IVT, there aren’t enough studies to investigate the effect of PC on mortality, functional outcome, and risk of bleeding. In the study of Gensicke et al, 24 it was reported that as PC decreased, the risk of sICH increased, but the mortality and poor outcome decreased. We have seen in our study that the number of platelets is not related to the functional outcome.…”

Section: Discussionmentioning

confidence: 95%

Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Çetiner

Aydın

Güler

et al. 2018

Clin Appl Thromb Hemost

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The objective of our study is to detect the patient group that will most benefit from intravenous (IV) thrombolytic therapy by showing predictive factors of good functional outcomes. The present study covers 88 patients who were admitted to our clinic within the first 4.5 hours from the onset of stroke symptoms, diagnosed with acute ischemic stroke and who received IV thrombolytic therapy between May 2014 and June 2017 as a result of a retrospective analysis of a database prospectively collected. The patients with a score of ≤2 on modified Rankin scale within 3 months were accepted as good functional outcome and those with a score of >2 were accepted as poor functional outcome. As a result, within the period of 3 months posttreatment, good functional outcomes were obtained in 45 (51.1%) patients and poor functional outcomes were obtained in 43 (48.9%) patients. In comparisons, cardioembolic stroke group was statistically significantly higher in the good functional outcome group ( P = .03). Pretreatment National Institute of Health Stroke Scale (NIHSS) scores ( P < .001), presence of proximal hyperintense middle cerebral artery sign in noncontrast computed brain tomography ( P = .03), and being aged ≥80 and older ( P = .04) were markedly higher in the group with poor functional outcomes. In conclusion, our study demonstrated that cardioembolic strokes may have an impact on good functional outcomes and being aged 80 and older, presence of proximal HMCAS in computed brain tomography, and pretreatment NIHSS scores may have an impact on poor functional outcomes.

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Section: Discussionmentioning

confidence: 95%

Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Çetiner

Aydın

Güler

et al. 2018

Clin Appl Thromb Hemost

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“…On the other hand, rapid testing of the platelet count is a well-established standard in the treatment of stroke. Here, low platelet counts are excluded from tPA treatment due to the significantly increased risk of hemorrhagic transformation (HT) in platelet depleted patients (11). However, the question of whether and how platelet function contributes to tPA-associated HT has not been answered to date.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Platelet Function in an Experimental Stroke Model With Aspirin and Clopidogrel Treatment

et al. 2020

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Dual antiplatelet treatment (DAPT) increases the risk of tPA-associated hemorrhagic transformation (HT) in ischemic stroke. To investigate the effects of DAPT in rodents, reliable indicators of platelet function utilizing a minimally invasive procedure are required. We here established a fluorescence-based assay to monitor DAPT efficiency in a mouse model of ischemic stroke with HT. Male C57/BL6 mice were fed with aspirin and clopidogrel (ASA+CPG). Venous blood was collected, stimulated with thrombin, labeled with anti-CD41-FITC and anti-CD62P-PE, and analyzed by flow cytometry. Subsequently, animals were subjected to experimental stroke and tail bleeding tests. HT was quantified using NIH ImageJ software. In ASA+CPG mice, the platelet activation marker CD62P was reduced by 40.6 ± 4.2% (p < 0.0001) compared to controls. In vitro platelet function correlated inversely with tail bleeding tests (r = −0.8, p = 0.0033, n = 12). Twenty-four hours after drug withdrawal, platelet activation rates in ASA+CPG mice were still reduced by 20.2 ± 4.1% (p = 0.0026) compared to controls, while tail bleeding volumes were increased by 4.0 ± 1.4 µl (p = 0.004). Conventional tests using light transmission aggregometry require large amounts of blood and thus cannot be used in experimental stroke studies. In contrast, flow cytometry is a highly sensitive method that utilizes small volumes and can easily be incorporated into the experimental stroke workflow. Our test can be used to monitor the inhibitory effects of DAPT in mice. Reduced platelet activation is indicative of an increased risk for tPA-associated cerebral hemorrhage following experimental stroke. The test can be applied to individual animals and implemented flexibly prior and subsequent to experimental stroke.

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“…Among all the enrolled patients in the registry, 21,592 were diagnosed with ischemic stroke or TIA and therein 16,842 patients with PC within a priori defined range of 100–400 × 10 9 /L were involved in the current analysis after excluding patients with pregnancy/within post-partum 6 weeks ( n = 3), sickle-cell disease ( n = 1), thrombocytopenia (8) (PC < 100 × 10 9 /L) ( n = 542), and thrombocytosis (9) (PC > 450 × 10 9 /L) ( n = 33), bleeding tendency/history caused by blood platelet disorders or coagulation factor deficiency ( n = 114), missing PC ( n = 1,703), and lost to 1 year follow-up ( n = 2,354).…”

Section: Methodsmentioning

confidence: 99%

Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II

Yang

Pan

et al. 2019

Front. Neurol.

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Background: The clinical significance of platelet count (PC) for ischemic cerebrovascular disease is not well-established and further risk stratification according to baseline PC within normal range has not been reported before. We aim to evaluate the prognostic effect of baseline circulating PC within normal range on the risk of long-term recurrent stroke, mortality and functional outcomes after ischemic stroke or TIA. Methods: We derived data from eligible patients with ischemic stroke or TIA from the China National Stroke Registry (CNSR) II. Participants were divided into quintiles according to baseline PC within normal range (100–450 × 10 9 /L). Multivariable cox regression and logistic regression were adopted to explore the correlation of baseline PC with recurrent stroke, mortality and poor functional outcomes (modified Rankin Scale 3~6) within 1-year follow-up. Results: Among the16842 eligible participants, the average age was 64.7 ± 11.9, 1,241 (7.4%) had recurrent stroke, 1,377 (8.2%) died, and 3,557 (21.1%) ended up with poor functional outcomes after 1-year follow-up. Compared with the third PC quintile (186–212 × 10 9 /L), patients in the top quintile (249–450 × 10 9 /L) presented with increased risk of recurrent stroke (adjusted hazard ratio 1.21, [1.02–1.45]), all-cause mortality (adjusted hazard ratio 1.43, [1.19–1.73]), and poor functional outcome (adjusted odds ratio 1.49, [1.28–1.74]), while patients in the lowest PC quintile(100–155 × 10 9 /L) had higher risk of poor functional outcome (adjusted odds ratio 1.19, [1.02–1.38]). Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome.

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Intravenous thrombolysis and platelet count

Abstract: Lower PC was associated with increased risk of sICH, while higher PC indicated increased mortality. Our data suggest that PC modifies outcome and complications in individual patients, while withholding IVT in all patients with PC < 100 × 10/L is challenged.

Cited by 45 publications

References 30 publications

Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Measurement of Platelet Function in an Experimental Stroke Model With Aspirin and Clopidogrel Treatment

Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II

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