Wiśniewski Adam, Filipska Karolina, Sikora Joanna, Ślusarz Robert, Kozera Grzegorz
Department of Neurology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Department of Neurological and Neurosurgical Nursing, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-821 Bydgoszcz, Poland.
J Clin Med. 2020 Mar 20;9(3):859. doi: 10.3390/jcm9030859.
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.
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).
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, = 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; = 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 ( = 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, = 0.0322).
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.
阿司匹林反应降低可能导致缺血性卒中预后更差及临床结局不佳。这项前瞻性初步研究的目的是评估血小板反应性与缺血性卒中早期和晚期预后、临床及功能状态之间的关系，以及卒中病因的作用。
该研究纳入69例缺血性卒中患者，分为大血管和小血管病因亚组。采用两种凝集测定方法（阻抗法和光学法）进行血小板功能检测，同时在卒中第1天和第8天（早期预后）以及第90天（晚期预后）使用美国国立卫生研究院卒中量表（NIHSS）评估临床状况，使用改良Rankin量表（mRS）评估功能状态。
发现卒中后第90天神经功能缺损严重的患者初始血小板反应性高于神经功能缺损轻微的患者（曲线下面积（AUC）中位数分别为40单位和25单位，P = 0.033）。在大血管疾病组中，发现卒中第1天血小板反应性与功能状态之间存在显著相关性（相关系数（R）= 0.4526；P = 0.0451），卒中第1天临床状况严重的亚组血小板反应性高于临床状况轻微的亚组（P = 0.0372），与对阿司匹林敏感的患者相比，对乙酰水杨酸（阿司匹林）耐药的患者在卒中第1天出现严重神经功能缺损的可能性显著更高（比值比（OR）= 14.00，95%置信区间（CI）1.25 - 156.12，P = 0.0322）。
无论病因如何，缺血性卒中治疗中血小板反应性高与晚期预后较差相关。我们证明了大血管病因亚组中血小板反应性高与早期预后较差以及临床和功能状况不佳之间存在显著关系。然而，由于本研究的初步性质，其结果应谨慎解释，需要在更大队列中进一步验证。
