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Open AccessArticle

The Prognostic Value of High Platelet Reactivity in Ischemic Stroke Depends on the Etiology: A Pilot Study

1
Department of Neurology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
2
Department of Neurological and Neurosurgical Nursing, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-821 Bydgoszcz, Poland
3
Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
4
Medical Simulation Centre, Medical University of Gdańsk, Faculty of Medicine, 80-210 Gdańsk, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 859; https://doi.org/10.3390/jcm9030859
Received: 8 February 2020 / Revised: 18 March 2020 / Accepted: 19 March 2020 / Published: 20 March 2020
(This article belongs to the Special Issue Diagnosis, Prevention and Treatment for Stroke)
Background: Reduced aspirin response may result in a worse prognosis and a poor clinical outcome in ischemic stroke. The aim of this prospective pilot study was to assess the relationship between platelet reactivity and early and late prognosis, and the clinical and functional status in ischemic stroke, with the role of stroke etiology. Methods: The study involved 69 subjects with ischemic stroke, divided into large and small vessel etiological subgroups. Platelet function testing was performed with two aggregometric methods—impedance and optical—while the clinical condition was assessed using the National Institute of Health Stroke Scale (NIHSS) and the functional status was assessed using the modified Rankin Scale (mRS) on the first and eighth day (early prognosis) and the 90th day of stroke (late prognosis). Results: The initial platelet reactivity was found to be higher in patients with severe neurological deficits on the 90th day after stroke, than in the group with mild neurological deficits (median, respectively, 40 area under the curve (AUC) units vs. 25 AUC units, p = 0.033). In the large vessel disease group, a significant correlation between the platelet reactivity and the functional status on the first day of stroke was found (correlation coefficient (R) = 0.4526; p = 0.0451), the platelet reactivity was higher in the subgroup with a severe clinical condition compared to a mild clinical condition on the first day of stroke (p = 0.0372), and patients resistant to acetylsalicylic acid (aspirin) had a significantly greater possibility of a severe neurological deficit on the first day of stroke compared to those who were sensitive to aspirin (odds ratio (OR) = 14.00, 95% confidence interval (CI) 1.25–156.12, p = 0.0322). Conclusion: High on-treatment platelet reactivity in ischemic stroke was associated with a worse late prognosis regardless of the etiology. We demonstrated a significant relationship between high platelet reactivity and worse early prognosis and poor clinical and functional condition in the large vessel etiologic subgroup. However, due to the pilot nature of this study, its results should be interpreted with caution and further validation on a larger cohort is required. View Full-Text
Keywords: ischemic stroke; platelet reactivity; aspirin resistance; large vessel disease; carotid stenosis; clinical outcome; prognosis ischemic stroke; platelet reactivity; aspirin resistance; large vessel disease; carotid stenosis; clinical outcome; prognosis
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MDPI and ACS Style

Wiśniewski, A.; Filipska, K.; Sikora, J.; Ślusarz, R.; Kozera, G. The Prognostic Value of High Platelet Reactivity in Ischemic Stroke Depends on the Etiology: A Pilot Study. J. Clin. Med. 2020, 9, 859.

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