Mao Yusheng, Zhu Bangqiang, Wen Huiqin, Zhong Tao, Bian Maohong
Department of Blood Transfusion, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.
Department of Blood Transfusion, The People's Hospital of Chizhou, Chizhou, Anhui Province, People's Republic of China.
Int J Gen Med. 2024 Mar 23;17:1127-1138. doi: 10.2147/IJGM.S450059. eCollection 2024.
Ischemic stroke recurrence (ISR) is prevented by inhibiting platelet function. To investigate the impact of high on-treatment platelet reactivity (HTPR) assessed by thromboelastography (TEG) and its risk factors on ISR in individuals who have experienced acute ischemic stroke (AIS) receiving dual anti-platelet therapy (DAPT).
At the end of follow-up, a total of 264 patients who met the criteria were enrolled in this cohort study. The primary endpoint event was a recurrence of ischemic stroke within 90 days of onset.
The ISR rate was 7.2% (19/264). The recurrence rate in the HTPR group was 15.1% (8/53), which was significantly higher than the 5.2% (11/211) in the non-HTPR group (p = 0.013), and the type 2 diabetes mellitus (T2DM) group (12.5%, 10/80) was also significantly higher compared to the non-T2DM group (4.9%, 9/184) (p = 0.028). T2DM was an isolated risk factor for HTPR (adjusted OR = 3.06, 95% CI 1.57-5.98, P = 0.001). Kaplan-Meier plots showed that the cumulative risk (CR) of ISR was statistically different in the HTPR and T2DM groups compared to the non-HTPR group (log-rank P = 0.009) and the non-T2DM group (log-rank P = 0.026), respectively. The HTPR and T2DM groups had greater hazard ratios (HR) of ISR than the non-HTPR (adjusted HR = 2.78, 95% CI 1.06-7.32, P = 0.038) and non-T2DM (adjusted HR = 2.64, 95% CI 1.01-6.92, P = 0.049) groups.
Both HTPR and T2DM are linked to ISR. Platelet Inhibition Rate (PIR) of TEG can early identify patients who are at high risk for having another ischemic stroke in patients undergoing DAPT, and this study may offer more evidence in favor of clinically personalized treatment and secondary prevention tactics.
通过抑制血小板功能来预防缺血性中风复发（ISR）。旨在研究经血栓弹力图（TEG）评估的高治疗期血小板反应性（HTPR）及其危险因素对接受双重抗血小板治疗（DAPT）的急性缺血性中风（AIS）患者ISR的影响。
随访结束时，共有264名符合标准的患者纳入本队列研究。主要终点事件为发病90天内缺血性中风复发。
ISR发生率为7.2%（19/264）。HTPR组的复发率为15.1%（8/53），显著高于非HTPR组的5.2%（11/211）（p = 0.013），2型糖尿病（T2DM）组（12.5%，10/80）与非T2DM组（4.9%，9/184）相比也显著更高（p = 0.028）。T2DM是HTPR的独立危险因素（调整后的OR = 3.06，95% CI 1.57 - 5.98，P = 0.001）。Kaplan-Meier曲线显示，与非HTPR组（对数秩检验P = 0.009）和非T2DM组（对数秩检验P = 0.026）相比，HTPR组和T2DM组ISR的累积风险（CR）在统计学上有差异。HTPR组和T2DM组ISR的风险比（HR）高于非HTPR组（调整后的HR = 2.78，95% CI 1.06 - 7.32，P = 0.038）和非T2DM组（调整后的HR = 2.64，95% CI 1.01 - 6.92，P = 0.049）。
HTPR和T2DM均与ISR相关。TEG的血小板抑制率（PIR）可早期识别接受DAPT治疗的患者中再次发生缺血性中风的高危患者，本研究可能为临床个性化治疗和二级预防策略提供更多证据支持。
