Mean Platelet Volume is a Prognostic Marker in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Sotero, Filipa Dourado; Calçada, Alexandre; Sousa, Diana Aguiar de; Dias, Mariana Carvalho; Fonseca, Ana Catarina; Melo, Teresa Pinho e; Canhão, Patrı́cia

doi:10.1016/j.jstrokecerebrovasdis.2021.105718

Cited by 10 publications

(13 citation statements)

References 27 publications

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“…We believe these valuable findings support the significance of the admission PC association with unfavorable outcomes discovered in our study. However, Chen et al and Sotero et al showed no association between PC and outcome in AIS patients [ 34 , 35 ]. They both included patients with any admission NIHSS score.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in patient cohorts could explain the differences in these studies’ findings. In addition, several studies have found that an increased MPV value is associated with unfavorable outcomes in stroke patients [ 24 , 35 , 36 ]. MPV reflects platelet functional changes and activation based on average platelet size [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to those studies, our sample only included patients who were successfully recanalized with MT, perhaps rendering the possible explanation inapplicable; thus, we did not find any significant association between MPV values and unfavorable outcomes. Furthermore, unlike the aforementioned studies reporting an association between unfavorable outcomes and MPV in stroke patients [ 24 , 35 , 36 ], our cohort only included patients with an admission NIHSS score ≥ 21, implying that MPV may have been insignificant in our subgroup. The relationship between increased MPV and prognosis in patients with AIS is still debatable, so larger-scale studies are required [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Ozkara

Karabacak

Kotha

et al. 2023

Neurology International

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Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0–3) or unfavorable functional outcome (mRS 4–6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Ozkara

Karabacak

Kotha

et al. 2023

Neurology International

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“…In comparison, the initial randomized-controlled trials leading to the approval of r-tPA reported excellent functional outcome (defined as mRS score of 0-1) in 39% of r-tPA-treated patients in the NINDs-trial 1 and favorable functional outcome (defined as mRS score of 0-2) in 54.3% of r-tPA-treated patients in the ECASS II-trial (European Cooperative Acute Stroke Study), 16 respectively. Observational studies assessing the mRS at 3 months after thrombolysis report frequencies of favorable outcome from 36.3% 17 to 61.3% for patients with…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends of Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Marko

Mikšová

Ebner

et al. 2022

Stroke

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Background: Intravenous thrombolysis improves functional outcome in patients with acute stroke and frequencies of r-tPA (recombinant tissue-type plasminogen activator) treatment have been increasing over time. We aimed to assess whether functional outcome in r-tPA–treated patients improved over time and to investigate the influence of clinical variables on functional outcome. Methods: We analyzed data of r-tPA–treated patients in the Austrian Stroke Unit Registry from 2006 to 2019. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 2. Frequencies of modified Rankin Scale score of 0 to 2 were assessed for the overall population and in prespecified subgroups; multivariable logistic regression analysis was performed to assess associations of baseline characteristics including clinically relevant interactions, and outcome. Results: Overall, 4865 out of 9409 r-tPA–treated patients (51.7%) achieved favorable functional outcome 3 months post stroke. Between 2006 and 2019, frequencies of favorable functional outcome increased from 45.9% to 56.8%. In multivariable logistic regression analysis, year of treatment (adjusted odds ratio [adjOR], 1.08 [95% CI, 1.01–1.15]) was associated with favorable functional outcome. Stroke severity (National Institutes of Health Stroke Scale, adjOR, 0.86 [95% CI, 0.85–0.87]), age (61–70 years: adjOR, 0.67 [95% CI, 0.55–0.80], 71–80 years: adjOR, 0.42 [95% CI, 0.35–0.50], >80 years: adjOR, 0.16 [95% CI, 0.13–0.20]), female sex (adjOR, 0.89 [95% CI, 0.79–0.99]), and various comorbidities (eg, atrial fibrillation, prior stroke, diabetes) were negatively associated. Inclusion of interaction terms into the multivariable logistic regression model suggests a positive effect of year of treatment and endovascular treatment by increasing stroke severity on functional outcome (interaction between year of treatment and National Institutes of Health Stroke Scale: adjOR, 1.01 [95% CI, 1.00–1.02], interaction between National Institutes of Health Stroke Scale and endovascular treatment: adjOR, 1.02 [95% CI, 1.01–1.03]). Conclusions: Frequencies of favorable functional outcome in r-tPA–treated patients have been increasing over time, likely driven by improved outcome in patients with more severe strokes receiving endovascular treatment. However, some subgroups are still less likely to achieve functional independency and deserve particular attention.

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“…It has been observed that platelet activation, as evidenced by increased mean platelet volume, begins in AIS patients ( 20 ). The increase in platelet volume also predicts poor recovery of AIS patients at 3 months ( 21 , 22 ). Thus, inhibition of platelet activation has become the standard therapeutic strategy for AIS patients.…”

Section: Discussionmentioning

confidence: 99%

Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis

Zhang

Wang

et al. 2022

Front. Neurol.

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BackgroundIntravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban treatment in AIS patients with early neurological deterioration (END) after IVT.MethodsIn this prospective and randomized pilot study, 73 AIS patients with END were recruited from a local hospital in China. Of these, 14 patients were treated with regular antiplatelet agents (aspirin plus clopidogrel) and 59 patients were treated with tirofiban within 24 h of IVT, followed by regular antiplatelet therapy. Neurological deficits and functional recovery were assessed with NIHSS and modified Rankin Scale (mRS) at 7 and 90 days. During the 90-day follow-up period, both hemorrhagic (e.g., intracerebral hemorrhage) and non-hemorrhagic (e.g., pneumonia) events were recorded.ResultsTreatment with tirofiban compared with regular antiplatelet therapy: (1) improved functional recovery of AIS patients to mRS (≤2) at both 7 and 90 days (odds ratios [ORs], 1.37 and 1.64; 95% confidence interval [CI], 1.16–1.61 and 1.26–2.12; P = 0.008 and < 0.001, respectively), and (2) reduced NIHSS scores from 11.14 ± 2.38 to 5.95 ± 3.48 at day 7 (P < 0.001) and from 8.14 ± 2.74 to 4.08 ± 3.50 at day 90 (P < 0.001). Tirofiban treatment did not increase the risk of hemorrhagic complications. Multivariate regression analysis showed that tirofiban treatment independently predicted a favorable functional outcome (P ≤ 0.001).ConclusionEarly treatment with low-dose tirofiban in AIS patients with neurologic deterioration after IVT potentially improved functional recovery and attenuated neurologic deficits as early as 7 days and did not increase the risk of various hemorrhagic complications. However, the therapeutic efficacy of tirofiban treatment in END patients needs to be determined by future randomized clinical trials with a large study population.Clinical trial registrationhttp://www.chictr.org.cn/, Identifier ChiCTR2200058513.

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Mean Platelet Volume is a Prognostic Marker in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Cited by 10 publications

References 27 publications

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study

Temporal Trends of Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis

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