Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

Abstract

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

Evaluation of circulating endothelial progenitor cells and the severity of transient ischemic attack

“…Studies have shown that patients with smaller cerebral infarction volumes and slower progression have higher circulating EPCs than those with large Unlike cerebral infarction and myocardial infarction, no studies have addressed the role of circulating EPCs in risk assessment after TIA. The current methods for predicting TIA recurrence and aggravation include clinical predictive factors [21][22], image predictive factors [23][24], and biomarker predictive factors [25][26]. The commonly used clinical tool for predicting the recurrence of TIA is the ABCD2 score; however, some studies have found that patients with an ABCD2 score <4 have a stroke recurrence rate up to 4.1% at 2 days [27].…”

The role of viscoelastic testing in assessing peri-interventional platelet function and coagulation

“…The addition of the AA-and ADP-based VHA allows platelet function to be assessed alongside coagulation dynamics, so that clinicians can determine response to therapy, and to assess the relative contribution of platelet function and coagulation dynamics, and individually schedule major surgery without increased bleeding risk [47,126]. While TEG® and ROTEM® devices performed similarly for standard platelet count assays, the addition of platelet function assays may enhance the utility of management algorithms in surgical patients [44,92,127].…”

“…Platelet count assays are commonly used in neurology and neurosurgery to monitor hemostasis and assess blood transfusion requirements. The standard global hemostatic VHA showed some predictive value for recurrent ischemic events [92], with coagulation assays able to detect the differences in coagulopathy associated with dual antiplatelet therapy [93]. Platelet function assays have further demonstrated a correlation between platelet dysfunction and subsequent ischemic events following stroke and DOI: https://doi.org/10.1080/09537104.2021.1961709 may be used to predict the risk of future thromboembolic complications [94][95][96][97].…”

The Relationship Between Transthoracic Echocardiography Findings, Localization of Stroke, and Risk Factors in Patients With Ischemic Stroke

“…The most common reason for death is the circulatory system diseases in our country as well as in the whole world 8,9 ; therefore, detection and treatment of cardiac risk factors is mandatory to prevent both the first ischemic stroke and recurrences 10 . It is observed that patients with ischemic stroke have different cardiac pathologies such as atrial fibrillation (AF), CAD, pulmonary hypertension, prosthetic heart valves, patent foramen ovale (PFO), and previous myocardial infarction.…”