Platelet Function Testing in Patients with Acute Ischemic Stroke: An Observational Study

Rosafio, Francesca; Lelli, Nicoletta; Mimmi, Stefano; Vandelli, Laura; Bigliardi, Guido; Dell’Acqua, Maria Luisa; Picchetto, Livio; Pentore, Roberta; Ferraro, Diana; Trenti, Tommaso; Nichelli, Paolo Frigio; Zini, Andrea

doi:10.1016/j.jstrokecerebrovasdis.2017.04.023

Cited by 15 publications

(23 citation statements)

References 50 publications

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“…Data from the literature provides information that the fact of taking ASA before stroke is relevant to the results obtained. Rosafio et al [23] and Sabra et al [24] showed significant differences in platelet reactivity between a group that took ASA for the first time in the acute phase of stroke and a group that had received ASA prior to stroke. In addition, some authors have shown that taking ASA before has a potential effect on the size of an ischemic focus [25].…”

Section: Discussionmentioning

confidence: 99%

High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

Wiśniewski

Sikora

Sławińska

et al. 2020

JCM

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Background: Excessive platelet activation and aggregation plays an important role in the pathogenesis of ischemic stroke. Correlation between platelet reactivity and ischemic lesions in the brain shows contradictory results and there are not enough data about the potential role of stroke etiology and its relationships with chronic lesions. The aim of this study is to assess the relationship between platelet reactivity and the extent of ischemic lesions with the particular role of etiopathogenesis. Methods: The study involved 69 patients with ischemic stroke, including 20 patients with large-vessel disease and 49 patients with small-vessel disease. Evaluation of platelet reactivity was performed within 24 h after the onset of stroke using two aggregometric methods (impedance and optical), while ischemic volume measurement in the brain was performed using magnetic resonance imaging (in diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences) at day 2–5 after the onset of stroke. Results: In the large-vessel disease subgroup, a correlation was found between platelet reactivity and acute ischemic focus volume (correlation coefficient (R) = 0.6858 and p = 0.0068 for DWI; R = 0.6064 and p = 0.0215 for FLAIR). Aspirin-resistant subjects were significantly more likely to have a large ischemic focus (Odds Ratio (OR) = 45.00, 95% Confidence Interval (CI) = 1.49–135.36, p = 0.0285 for DWI; OR = 28.00, 95% CI = 1.35–58.59, p = 0.0312 for FLAIR) than aspirin-sensitive subjects with large-vessel disease. Conclusion: In patients with ischemic stroke due to large-vessel disease, high on-treatment platelet reactivity affects the extent of acute and chronic ischemic lesions.

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Section: Discussionmentioning

confidence: 99%

High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

Wiśniewski

Sikora

Sławińska

et al. 2020

JCM

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“…In a recent longitudinal observational study investigating platelet function by means of multiple electrode aggregometry in 624 stroke patients on anti-platelet therapy, 11% of patients with a stroke while on aspirin had high on-treatment platelet reactivity, and treatment with clopidogrel was accompanied by even higher proportions of unresponsiveness (36%), independent of the etiologic sub-type of stroke. 129 Rates of responsiveness to clopidogrel were not associated with CYP2C19 polymorphisms. In this context, Kunicki et al investigated the effect of aspirin on platelet function in 463 patients with stroke, transient ischaemic attack or acute coronary syndrome.…”

Section: Shortcomings Of Current Stroke Prevention and Treatmentmentioning

confidence: 96%

Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence

Buchtele

Schwameis

Gilbert³

et al. 2018

Thromb Haemost

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Despite great efforts in stroke research, disability and recurrence rates in ischaemic stroke remain unacceptably high. To address this issue, one potential target for novel therapeutics is the glycoprotein von Willebrand factor (vWF), which increases in thrombogenicity especially under high shear rates as it bridges between vascular sub-endothelial collagen and platelets. The rationale for vWF as a potential target in stroke comes from four bodies of evidence. (1) Animal models which recapitulate the pathogenesis of stroke and validate the concept of targeting vWF for stroke prevention and the use of the vWF cleavage enzyme ADAMTS13 in acute stroke treatment. (2) Extensive epidemiologic data establishing the prognostic role of vWF in the clinical setting showing that high vWF levels are associated with an increased risk of first stroke, stroke recurrence or stroke-associated mortality. As such, vWF levels may be a suitable marker for further risk stratification to potentially fine-tune current risk prediction models which are mainly based on clinical and imaging data. (3) Genetic studies showing an association between vWF levels and stroke risk on genomic levels. Finally, (4) studies of patients with primary disorders of excess or deficiency of function in the vWF axis (e.g. thrombotic thrombocytopenic purpura and von Willebrand disease, respectively) which demonstrate the crucial role of vWF in atherothrombosis. Therapeutic inhibition of VWF by novel agents appears particularly promising for secondary prevention of stroke recurrence in specific sub-groups of patients such as those suffering from large artery atherosclerosis, as designated according to the TOAST classification.

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“…The response to aspirin was significantly better in combination with one of the two drugs used in this study and vice versa. Also, the combination of anticoagulant medication with a clopidogrel-type anti-aggregate potentiates the patient's response to treatment and improves the post-stroke hematoencephalic barrier activity in patient with severe heart disease [21,22].…”

Section: Resultsmentioning

confidence: 99%

Antithrombotic Therapy in Patients with Stroke An observational study

Cuciureanu¹,

Constantinescu²,

Stătescu³

et al. 2019

Rev. Chim.

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Cerebrovascular disease is the second leading cause of death in developed countries after cardiovascular disease, with a prevalence of 794 percent of hundred thousand of people. Ischemic stroke (IS) remains an important public health issue of great importance in terms of its reality and the morbidity it implies, although the tendency is to reduce epidemiological indicators. In this paper we have updated informations on etiopathogenesis, epidemiology, pathological anatomy, clinical, laboratory and imaging investigations, differential diagnosis, evolution, complications, prophylaxis with antiplatelet treatment of patients with IS. IS remains an important public health issue of great importance in terms of its reality and the morbidity it implies, although the tendency is to reduce epidemiological indicators. Platelet function testing may potentially be useful in monitoring the biological effect of platelet antiaggregant medication. Aggregometry could provide personalized prognostic information and may thus become a useful tool in designing strategies for prevention and management of ischemic stroke.

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Platelet Function Testing in Patients with Acute Ischemic Stroke: An Observational Study

Cited by 15 publications

References 50 publications

High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease

Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence

Antithrombotic Therapy in Patients with Stroke An observational study

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