Stroke Unit, Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria.
Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
J Stroke Cerebrovasc Dis. 2021 Jun;30(6):105718. doi: 10.1016/j.jstrokecerebrovasdis.2021.105718. Epub 2021 Apr 7.
There is conflicting data regarding the association between platelet parameters and prognosis of stroke patients treated with intravenous thrombolysis. We aimed to analyze this association in a cohort of patients treated with rtPA.
Retrospective, observational study in adult ischemic stroke patients treated with rtPA between January 2015 and February 2017. Demographic and clinical characteristics, stroke severity (NIHSS), etiology (TOAST), mean platelet volume (MPV), platelet count (PC), platelet distribution width (PDW) and functional outcome (mRS) at discharge and 90 days were recorded. The association between platelet parameters and unfavorable prognosis (mRS 3-6) was tested using non-parametric tests and logistic regression analysis.
267 patients were included, 134 (50.2%) females, with a median (IQR) age of 74 years (64-82). The median admission NIHSS was 14 (8-19) and the most frequent etiology was cardioembolism (n = 115, 43.1%). At discharge, 170 (63.7%) patients had mRS 3-6. MPV values were higher in patients with mRS 3-6 (median 8.2fL versus 7.8fL, p = 0.013). This association remained significant (OR = 1.36, 95% CI 1.003-1.832, p = 0.048) after adjustment for variables associated with prognosis. There were no significant associations between other platelet parameters and prognosis. There was a trend to unfavorable prognosis at 90 days in patients with higher MPV. Regarding the association between platelet parameters and hemorrhagic transformation, higher PDW was associated with more severe hemorrhagic transformation (PH1/PH2).
Higher MPV values were associated with unfavorable prognosis at discharge in patients treated with intravenous thrombolysis. Future studies should address its added value in stroke prediction models.
静脉溶栓治疗的脑卒中患者血小板参数与预后的相关性存在争议。我们旨在分析接受 rtPA 治疗的患者队列中的这种相关性。
回顾性观察性研究，纳入 2015 年 1 月至 2017 年 2 月接受 rtPA 治疗的成年缺血性脑卒中患者。记录人口统计学和临床特征、卒中严重程度（NIHSS）、病因（TOAST）、平均血小板体积（MPV）、血小板计数（PC）、血小板分布宽度（PDW）和出院时及 90 天时的功能结局（mRS）。采用非参数检验和逻辑回归分析检验血小板参数与不良预后（mRS 3-6）的相关性。
共纳入 267 例患者，女性 134 例（50.2%），中位（IQR）年龄 74 岁（64-82）。入院 NIHSS 中位数为 14（8-19），最常见的病因是心源性栓塞（n=115，43.1%）。出院时，170 例（63.7%）患者 mRS 为 3-6。mRS 为 3-6 的患者的 MPV 值较高（中位数 8.2fL 与 7.8fL，p=0.013）。在校正与预后相关的变量后，这种相关性仍然显著（OR=1.36，95%CI 1.003-1.832，p=0.048）。其他血小板参数与预后之间无显著相关性。在 MPV 较高的患者中，90 天时预后不良的趋势更为明显。关于血小板参数与出血性转化的相关性，较高的 PDW 与更严重的出血性转化（PH1/PH2）相关。
静脉溶栓治疗的脑卒中患者中，较高的 MPV 值与出院时的不良预后相关。未来的研究应探讨其在卒中预测模型中的附加价值。
