Platelet function-guided modification in antiplatelet therapy after acute ischemic stroke is associated with clinical outcomes in patients with aspirin nonresponse

Abstract

PurposeTo investigate the association of clinical outcomes with platelet function-guided modification in antiplatelet therapy in patients with ischemic stroke.ResultsAmong 812 patients, 223 patients had aspirin nonresponse, 204 patients was modified in antiplatelet therapy after platelet function testing. Mean follow-up period was 4.8 ± 1.7 years (ranged from 1 to 6.4 years). The incidence rates of ischemic events, death, or bleeding events were not significantly different between the patients with and without antiplatelet therapy modification. However, in patients with aspirin nonresponse, antiplatelet therapy modification was associated with decreased ischemic events (hazard ratio, 0.67; 95% confidence interval [CI], 0.62–0.97; P = 0.01) and ischemic stroke (hazard ratio, 0.70; 95% CI, 0.63–0.98; P = 0.03) compared with no modification in antiplatelet therapy.ConclusionsIn patients with aspirin nonresponse, platelet function-guided modification in antiplatelet therapy after an ischemic stroke was associated with significantly lower rate of ischemic events. The platelet function testing may be useful to guide antiplatelet therapy modification.MethodsThis is a retrospective, multicentre study. From August 2010 to December 2014, 812 patients with ischemic stroke underwent platelet function testing using platelet aggregation. Antiplatelet therapy modification was defined as any change in antiplatelet therapy after testing, including increasing aspirin dosage, adding an additional antiplatelet agent to aspirin, or switching to a more potent antiplatelet agent. The primary outcome was ischemic events. Secondary outcomes included death and bleeding events. Clinical outcomes were compared between patients with and without antiplatelet therapy modification using univariate and propensity score-adjusted analyses.

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

“…We fully agree with the authors who customized antiplatelet therapy based on platelet function assays and their results that showed lower rates of recurrent events after platelet reactivity-guided modification of therapy [22,23]. In addition, there have been reports about dual antiplatelet therapy (ASA plus clopidogrel) that could be effective and beneficial for the large artery atherosclerosis etiologic subtype of stroke [24,25] and that dual antiplatelet therapy is associated with a lower risk of HTPR [7].…”

Effectiveness of Platelet Function Analysis-Guided Aspirin and/or Clopidogrel Therapy in Preventing Secondary Stroke: A Systematic Review and Meta-Analysis

“…We analyzed the overall effects of modification in antiplatelet therapy compared to aspirin and/or clopidogrel treatments without adjustment, and the effects of modification in antiplatelet therapy in aspirin non-responders [40,41]. The data for clopidogrel non-responders were not included in the metaanalysis, because they were reported only in one study [40].…”

Pitfall of Light Transmission Aggregometry-Based Assessment of Platelet Function in Acute Ischemic Stroke Patients

“…However, in acute ischemic stroke, the utility of LTA-based assessments of platelet hyperactivity and subsequent adjustment for antiplatelet therapy has been limited due to inconsistency of the results. [2][3][4][5][6] It is unknown why LTA does not always reflect actual platelet hyperactivity.…”