Role and Clinical Significance of Thromboelastography-Guided Individualized Antiplatelet Therapy in Non-cardiogenic Ischemic Stroke: A Retrospective Cohort Study

Abstract

This study examined the impact of individualized antiplatelet (IA) therapy guided by Thromboelastography (TEG) in non-cardiogenic ischemic stroke patients. The patients were divided into an IA group and a control group receiving conventional treatment. A one-year follow-up tracked mortality, bleeding events, and ischemic events. 715 patients were initially enrolled, with 684 meeting the inclusion criteria (487 in IA group, 197 in control group). IA therapy significantly reduced the composite rate of death, bleeding, or ischemic events compared to conventional therapy (7.39% vs. 15.74%, P = 0.001). The IA group showed a lower incidence of combined bleeding or ischemic events (6.98% vs. 15.32%, P = 0.001). Furthermore, the IA group had lower rates of ischemic stroke (2.46% vs. 5.58%, P = 0.04) and myocardial infarction (3.08% vs. 6.6%, P = 0.035) compared to the control group. Cox regression analysis revealed that age (hazard ratio, 1.043; 95% CI, 1.01-1.078, P = 0.011) and coronary artery disease (hazard ratio, 1.902; 95% CI, 1.147-3.153, P = 0.013) were associated with increased risk of adverse events compared to the control group. A therapy guided by platelet function testing can effectively reduce adverse events, particularly the risk of ischemic events, in the clinical prognosis of ischemic stroke. However, Caution is needed in IA therapy for elderly and coronary heart disease patients due to potential risks. Further large-scale experiments are required to validate and optimize personalized antiplatelet therapy in this population. Trial Registration clinicaltrials.gov Identifier: NCT 03471169