Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients

Wang, Chaowei; Su, Linlin; Hua, Qiuju; He, Yi; Fan, Yannan; Xi, Tingting; Yuan, Bin; Liu, Yanxia; Ji, Si-Bei

doi:10.1016/j.brainresbull.2018.07.004

Cited by 17 publications

(14 citation statements)

References 37 publications

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“…These findings are suggestive of a higher risk of stroke recurrence in patients with HTPR. This view is supported by other studies [26,27,[29][30][31].…”

Section: Introductionsupporting

confidence: 85%

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

Yan¹,

Naunton²,

Peterson³

et al. 2020

Preprint

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Background: Antiplatelet medications such as aspirin and clopidogrel are used following thrombotic stroke or transient ischemic attack (TIA) to prevent a recurrent stroke. However, the antiplatelet treatments fail frequently, and patients experience recurrent stroke. One approach to lower the rates of recurrence, may be the individualized antiplatelet therapies (antiplatelet therapy modification (ATM)) based on the results of platelet function analysis (PFA). This review was undertaken to gather and analyse the evidence about the effectiveness of such approaches. Methods: We searched Medline, CINAHL, Embase, Web of Science and Cochrane databases to 7 January 2020. Results: Two observational studies involving 1136 patients were included. The overall effects of PFA-based ATM on recurrent strokes (OR 1.05; 95% CI 0.69 to 1.58), any bleeding risk (OR 1.39; 95% CI 0.92 to 2.10) or death hazard from any cause (OR 1.19; 95% CI 0.62 to 2.29) were not significantly different from the standard antiplatelet therapy without ATM. Conclusions: The two studies showed opposite effects of PFA-guided ATM on the recurrent strokes in aspirin non-responders, leading to an insignificant difference in the subgroup meta-analysis (OR 1.59; 95% CI 0.07 to 33.77), while the rates of any bleeding events (OR 1.04; 95% CI 0.49 to 2.17) or death from any cause (OR 1.17; 95% CI 0.41 to 3.35) were not significantly different between aspirin non-responders with ATM and those without ATM. There is a need for large randomized controlled trials which account for potential confounders such as ischemic stroke subtypes, technical variations in the testing protocols, patient adherence to therapy, and pharmacogenetic differences.

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“…These findings are suggestive of a higher risk of stroke recurrence in patients with HTPR. This view is supported by other studies [26,27,[29][30][31].…”

Section: Introductionsupporting

confidence: 85%

“…adults with ischemic stroke or transient ischemic attack(29) patients receiving aspirin and/or clopidogrel were followed up for clinical outcomes for at least 3 months (30) platelet function analysis (PFA) results were used for making decisions on the choice of antiplatelet drugs or doses…”

mentioning

confidence: 99%

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

Yan¹,

Naunton²,

Peterson³

et al. 2020

Preprint

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show abstract

“…Stroke is one of the leading causes of human death worldwide [1]. Focal cerebral ischemia is the major type of stroke, leading to rapid neuronal injury.…”

Section: Introductionmentioning

confidence: 99%

Systematic Study of the Immune Components after Ischemic Stroke Using CyTOF Techniques

Wang

Yao

et al. 2020

Journal of Immunology Research

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Stroke induces a robust inflammatory response. However, it still lacks a systematic view of the various immune cell types due to the limited numbers of fluorophore used in the traditional FACS technique. In our current study, we utilized the novel technique mass cytometry (CyTOF) to analyze multiple immune cell types. We detected these immune cells from the ischemic brain, peripheral blood, spleen, and bone marrow at different time courses after stroke. Our data showed (1) dynamic changes in the immune cell numbers in the ischemic brain and peripheral organs. (2) The expression levels of cell surface markers indicate the inflammation response status after stroke. Interestingly, CD62L, a key adhesion molecule, regulates the migration of leukocytes from blood vessels into secondary lymphoid tissues and peripheral tissues. (3) A strong leukocyte network across the brain and peripheral immune organs was identified using the R program at day 1 after ischemia, suggesting that the peripheral immune cells dramatically migrated into the ischemic areas after stroke. This study provides a systematic, wide view of the immune components in the brain and peripheral organs for a deep understanding of the immune response after ischemic stroke.

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“…It has been reported that between 5% and 45% of the population has aspirin resistance (Mason Peter et al, 2005). Aspirin resistance may increase the risk of recurrence of stroke or myocardial infarction, and is closely related to its severity and infarct size of cerebral infarction (Cheng, Xie, Xu, Chen, & Lian, 2017;Wang et al, 2018;Yi et al, 2016). Clearly, a better understanding of the mechanism of aspirin resistance is critically important to designing new strategies to prevent cerebral infarction, reducing recurrence of cardio-cerebrovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

Association of aspirin resistance with 4‐hydroxynonenal and its impact on recurrent cerebral infarction in patients with acute cerebral infarction

et al. 2020

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Objectives To investigate the association of aspirin resistance (AR) with the plasma 4‐hydroxynonenal (4‐HNE) level and its impact on recurrent cerebral infarction (CI) in patients with acute cerebral infarction (ACI) who were receiving aspirin therapy. Methods One hundred and fifty‐four ACI patients who previously received aspirin therapy (100 mg/day) were enrolled. Whole urine (for measuring 11dhTXB2 and creatinine) along with blood (for measuring the plasma 4‐HNE level) were collected at least 7 days after the patients received aspirin. A cutoff of 1500 pg/mg of 11dhTXB2/ creatinine was used to determine AR. A follow‐up period to monitor recurrence CI events was 1 year. In addition, blood testing was performed when the patients were first admitted to hospital. Results Forty‐six of the 154 enrolled patients (29.9%) were found to be AR. No statistical difference in age, sex, hypertension, diabetes mellitus, coronary disease, smoking status, NIHSS score, TOAST classification, platelet count, thrombocytocrit, LDL‐C, HDL‐C, TG, and TC was found between the AR and aspirin‐sensitive (AS) patients, but the plasma 4‐HNE level was found to be higher in the AR patients than AS patients (p < .05). Multiple logistic regression analysis showed that the 4‐HNE level was associated with a higher risk of AR (OR = 1.034; 95% CI = 1.011–1.058; p < .05). Moreover, 1‐year follow‐up showed that AR was more prevalent in patients with recurrent CI (26 (56.6%)) than those without (20/(43.5%)) (p < .001). Conclusions The plasma 4‐HNE level is strongly associated with AR and thus may be a factor contributing to AR. Patients with AR have a greater risk of recurrence CI.

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Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients

Cited by 17 publications

References 37 publications

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

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

Systematic Study of the Immune Components after Ischemic Stroke Using CyTOF Techniques

Association of aspirin resistance with 4‐hydroxynonenal and its impact on recurrent cerebral infarction in patients with acute cerebral infarction

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