The Importance of Platelets Response during Antiplatelet Treatment after Ischemic Stroke—Between Benefit and Risk: A Systematic Review

Abstract

Ischemic stroke is a disease related to abnormal blood flow that leads to brain dysfunction. The early and late phases of the disease are distinguished. A distinction is made between the early and late stages of the disease, and the best effect in treating an ischemic stroke is usually achieved within the first hours after the onset of symptoms. This review looked at studies platelet activity monitoring studies to determine the risks and benefits of various approaches including antiplatelet therapy. A study was conducted on recently published literature based on PRISMA. This review includes 32 research articles directly addressing the importance of monitoring platelet function during antiplatelet therapy (dual or monotherapy) after ischemic stroke. In patients with transient ischemic attack or ischemic stroke, antiplatelet therapy can reduce the risk of stroke by 11–15%, assuming that patients respond well. Secondary prevention results are dependent on platelet reactivity, meaning that patients do not respond equally to antiplatelet therapy. It is very important that aspirin-resistant patients can benefit from the use of dual antiplatelet therapy. The individualized approach to secondary stroke prevention is to administer the most appropriate drug at the correct dose and apply the optimal therapeutic procedure to the individual patient.

Genetic Association Study and Machine Learning to Investigate Differences in Platelet Reactivity in Patients with Acute Ischemic Stroke Treated with Aspirin

“…The third limitation may be related to clinical outcome assessment. A number of studies confirmed an increased risk of adverse outcomes in patients with laboratory AR [ 14 , 15 , 16 , 17 ]. However, the underlying mechanism of a poor response to aspirin is still unclear.…”

“…Automated (point-of-care) assays such as VerifyNow ® , PFA-100 ® , Multiplate ® , Plateletworks ® and others are widely used for monitoring platelet response to antiplatelet agents including aspirin [ 6 , 12 , 13 ]. HTPR was shown to increase the risk of recurrent vascular events and long-term clinical outcomes for patients with cerebrovascular pathology [ 14 , 15 , 16 , 17 ]. Nevertheless, platelet function tests differ in their ability to predict the risk of cardiovascular outcomes [ 12 ].…”

Clinical Application of Thromboelastography in Acute Ischemic Stroke

“…Routine monitoring of platelet function in all ischemic stroke patients is not recommended, but it is necessary for patients with recurrent ischemic events. 75,76 Increasing evidence showed that the responses to antiplatelet agents are heterogeneous from non-responders to hyper-responders. 77,78 The phenomenon called antiplatelet resistance is associated with the recurrence of ischemic stroke.…”

Changes of platelet morphology, ultrastructure and function in patients with acute ischemic stroke based on super-resolution microscopy

“…AIS refers to the sudden termination of blood supply to the brain tissue when the cerebral blood flow is below the ischemic threshold (10-25% of baseline) [4], causing irreversible nerve cell damage in the corresponding ischemic area and eventually lead to nerve function impairment. Intracranial atherosclerosis is the most common cause of AIS, and platelets play an inevitable role in subsequent vascular blockage [5].…”