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

Abstract

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.

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study

“…Another novelty presented in this study is underlining the coexistence of aspirin resistance with the large-vessel disease etiology of cerebrovascular incidents and emphasizing the role of this etiology of stroke with a higher risk of recurrent events. In our previous study, we confirmed the role of large artery atherosclerosis for assessment of a significant relationship between platelet reactivity and the extent of brain ischemic lesions [6]. In this paper, we found that large-vessel disease is associated with high on-treatment platelet reactivity, and aspirin resistance and large vessel disease are independently associated with a higher rate of recurrent vascular events.…”

“…Previous literature reports demonstrated that aspirin resistance in stroke patients is associated with negative traits, including poor clinical condition, poor early and late prognosis, new ischemic changes, larger extent of brain lesions in neuroimaging, or a higher risk of death or recurrent vascular events [6,7]. In assessing the recurrence aspect, the focus was not on the time of occurrence of the event and usually the short-term follow-up period was taken into consideration.…”

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

“…One of the better-understood causes of cerebral ischemia is the pathology of large pre-cranial vessels, most often the internal carotid artery, which accounts for approximately 20-30% of all causes of stroke [6]. Our previous papers demonstrated the hyperaggregation and hyperactivation of platelets in this etiological subtype of ischemic stroke [7,8]. Furthermore, we hypothesize that it may be related to aspirin resistance and affect the clinical condition and prognosis due to the reduced inhibition of platelets.…”

Updates in Stroke Treatment, Diagnostic Methods and Predictors of Outcome

“…In a subsequent publication in the same issue of the Journal of Clinical Medicine, Wisniewski et al assessed the relationship of platelet reactivity with early and late prognosis after an acute ischemic stroke, according to the stroke etiology [29]. Performing platelet function testing with two aggregometric methods in 69 individuals, they found higher platelet reactivity in patients with severe neurological deficits on day 90 after stroke onset, when compared to the group of patients experiencing mild neurological deficits [29].…”

“…In a subsequent publication in the same issue of the Journal of Clinical Medicine, Wisniewski et al assessed the relationship of platelet reactivity with early and late prognosis after an acute ischemic stroke, according to the stroke etiology [29]. Performing platelet function testing with two aggregometric methods in 69 individuals, they found higher platelet reactivity in patients with severe neurological deficits on day 90 after stroke onset, when compared to the group of patients experiencing mild neurological deficits [29]. In patients with acute ischemic stroke attributed to large vessel disease, a significant correlation between the platelet reactivity and functional status on the first day was also uncovered, with patients resistant to aspirin having a significantly greater possibility of severe neurological deficits on the first day of stroke compared to their aspirin-sensitive counterparts [29].…”