Kirkpatrick Angelia C, Vincent Andrea S, Dale George L, Prodan Calin I
From the Departments of Medicine (A.C.K., G.L.D.) and Neurology (C.I.P.), University of Oklahoma Health Sciences Center; Cognitive Science Research Center (A.S.V.), University of Oklahoma; and Veterans Affairs Medical Center (A.C.K, C.I.P.), Oklahoma City.
Neurology. 2017 Jul 11;89(2):125-128. doi: 10.1212/WNL.0000000000004090. Epub 2017 Jun 7.
To examine the potential for coated-platelets, a subset of highly procoagulant platelets observed on dual agonist stimulation with collagen and thrombin, for predicting stroke at 30 days in patients with TIA.
Consecutive patients with TIA were enrolled and followed up prospectively. ABCD2 scores were obtained for each patient. Coated-platelet levels, reported as percent of cells converted to coated-platelets, were determined at baseline. The primary endpoint was the occurrence of stroke at 30 days. Receiver operator characteristic (ROC) analysis was used to calculate area under the curve (AUC) values for a model including coated-platelets to predict incident stroke at 30 days.
A total of 171 patients with TIA were enrolled, and 10 strokes were observed at 30 days. A cutoff of 51.1% for coated-platelet levels yielded a sensitivity of 0.80 (95% confidence interval [CI] 0.55-1.0), specificity of 0.73 (95% CI 0.66-0.80), positive predictive value of 0.16 (95% CI 0.06-0.26), and negative predictive value of 0.98 (95% CI 0.96-1.0). The adjusted hazard ratio of incident stroke in patients with coated-platelet levels ≥51.1% was 10.72 compared to those with levels <51.1%. ROC analysis showed significant improvement in the predictive ability of the coated-platelet model compared to ABCD2 score (AUC 0.78 ± 0.07 vs 0.54 ± 0.07, = 0.01).
These findings suggest a role for coated-platelets in risk stratification for stroke at 30 days after TIA.
研究包被血小板（在胶原和凝血酶双重激动剂刺激下观察到的高促凝性子集血小板）在预测短暂性脑缺血发作（TIA）患者30天内发生卒中方面的潜力。
连续纳入TIA患者并进行前瞻性随访。为每位患者获取ABCD2评分。在基线时测定包被血小板水平，以转化为包被血小板的细胞百分比表示。主要终点是30天时卒中的发生情况。采用受试者工作特征（ROC）分析来计算包含包被血小板的模型预测30天内新发卒中的曲线下面积（AUC）值。
共纳入171例TIA患者，30天时观察到10例卒中。包被血小板水平的截断值为51.1%时，敏感性为0.80（95%置信区间[CI] 0.55 - 1.0），特异性为0.73（95% CI 0.66 - 0.80），阳性预测值为0.16（95% CI 0.06 - 0.26），阴性预测值为0.98（95% CI 0.96 - 1.0）。与包被血小板水平<51.1%的患者相比，包被血小板水平≥51.1%的患者发生新发卒中的校正风险比为10.72。ROC分析显示，与ABCD2评分相比，包被血小板模型的预测能力有显著提高（AUC 0.78±0.07对0.54±0.07，P = 0.01）。
这些发现表明包被血小板在TIA后30天卒中风险分层中具有一定作用。
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