Ho Hsin-Ju, Wu Li-Ching, Chen Yu-Wei
Department of Biomedical Science and Engineering, Program in Systems Biology and Bioinformatics, National Central University, Taoyuan 320317, Taiwan.
Department of Neurology, National Taiwan University Hospital, Taipei 100225, Taiwan.
Diagnostics (Basel). 2024 Dec 18;14(24):2848. doi: 10.3390/diagnostics14242848.
This study investigated whether point-of-care platelet function measurements could predict favorable outcomes in patients with acute ischemic stroke (AIS). Antiplatelet agents, such as aspirin, are known to reduce the risk of recurrent stroke by 20-30%. However, identifying nonresponders to therapy remains a clinical challenge. The study aimed to assess the prognostic value of serial Platelet Function Analyzer (PFA)-100 measurements and hematological ratios in AIS patients.
A prospective cohort study was conducted on 212 AIS patients in Taiwan. Platelet function was assessed at baseline, week 2, and week 4 using PFA-100. The primary outcome was functional recovery, defined by a modified Rankin Scale (mRS) score of 0-3, at 1-month and 1-year. Subgroup analyses compared outcomes between pre- and post-aspirin administrations. Statistical analyses examined the association between changes in platelet function and clinical outcomes.
Difference in collagen and epinephrine (CEPI) measurements between baseline and week 2 was associated with favorable mRS scores ( < 0.001). A difference in CEPI closure time greater than 99 seconds was most predictive of a favorable outcome with an adjusted odds ratio of 11.859 (95% CI 2.318-60.669) at 1-month follow-up. Subgroup analyses revealed predictive value in pre-aspirin measurements at 1-month follow-up ( = 0.007).
Serial PFA-100 measurements and hematological biomarkers, specifically changes in on-treatment CEPI closure times, may help predict favorable clinical outcome in AIS patients. These findings suggest that dynamic platelet function assessment could play a role in optimizing antiplatelet therapy in AIS management.
本研究调查了即时血小板功能检测能否预测急性缺血性卒中（AIS）患者的良好预后。已知阿司匹林等抗血小板药物可将复发性卒中风险降低20%-30%。然而，识别治疗无反应者仍然是一项临床挑战。本研究旨在评估连续血小板功能分析仪（PFA）-100检测和血液学指标在AIS患者中的预后价值。
对台湾地区的212例AIS患者进行了一项前瞻性队列研究。在基线、第2周和第4周使用PFA-100评估血小板功能。主要结局是1个月和1年时的功能恢复情况，采用改良Rankin量表（mRS）评分0-3来定义。亚组分析比较了阿司匹林给药前后的结局。统计分析检测了血小板功能变化与临床结局之间的关联。
基线与第2周之间的胶原和肾上腺素（CEPI）检测结果差异与良好的mRS评分相关（<0.001）。CEPI封闭时间差异大于99秒最能预测良好结局，在1个月随访时调整后的优势比为11.859（95%CI 2.318-60.669）。亚组分析显示，在1个月随访时，阿司匹林治疗前的检测结果具有预测价值（=0.007）。
连续PFA-100检测和血液学生物标志物，特别是治疗期间CEPI封闭时间的变化，可能有助于预测AIS患者的良好临床结局。这些发现表明，动态血小板功能评估可能在优化AIS管理中的抗血小板治疗方面发挥作用。
