Key result
Unfavorable platelet reactivity dynamics during clopidogrel treatment predict worse severity and prognosis in ischemic stroke.
Why the study?
Previous studies linked high platelet reactivity on clopidogrel to worse ischemic stroke outcomes using only a single measurement, leaving the prognostic impact of platelet reactivity dynamics over time uncertain.
Do unfavorable dynamics of platelet reactivity over time predict severe clinical course and poor prognosis in ischemic stroke patients treated with clopidogrel?
Observational (n=74)
No
Do unfavorable dynamics of platelet reactivity over time predict severe clinical course and poor prognosis in ischemic stroke patients treated with clopidogrel?
Monitoring the dynamics of platelet reactivity over 48 hours provides better prognostic value for clinical outcomes in ischemic stroke patients on clopidogrel than a single measurement.
May support serial platelet reactivity monitoring for prognosis in clopidogrel-treated stroke; hypothesis-generating for outcome trials.
BACKGROUND: Previous studies have revealed that high platelet reactivity while on clopidogrel may affect the severe course and worse prognosis of ischemic stroke. However, the above findings were based on a single measurement of platelet function. We aimed to investigate whether the dynamics of platelet reactivity over time would more accurately determine its actual impact on clinical outcome. METHODS: We enrolled 74 ischemic stroke subjects, taking a dose of 75 mg a day of clopidogrel to this prospective, single-center, and observational study. The determination of platelet function was based on the impedance aggregometry 6-12 h after the first dose of clopidogrel and 48 h later. We defined a favorable dynamics of platelet reactivity as a decrease in values at least equal to the median obtained in the entire study. The clinical condition was assessed by the National Institutes of Health Stroke Scale on the first, third, and ninetieth days and the functional status by modified Rankin Scale, respectively. RESULTS: A favorable dynamics of platelet reactivity was associated with the mild clinical condition and favorable functional status, both early and late. Early neurological deterioration was related to unfavorable dynamics of platelet reactivity over time. In multivariate regression models, we found that unfavorable dynamics of platelet reactivity, alone and combined with a high baseline value of platelet reactivity, is an independent predictor of a severe clinical condition, the risk of deterioration, and poor early and late prognosis. CONCLUSION: We highlighted that dynamics of platelet reactivity over time predict the clinical course and prognosis of stroke better than a single value.
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Wiśniewski et al. (2021) conducted an observational in Ischemic stroke (n=74). Unfavorable dynamics of platelet reactivity vs. Favorable dynamics of platelet reactivity was evaluated on Clinical condition (NIHSS) and functional status (mRS) at days 1, 3, and 90. Unfavorable dynamics of platelet reactivity during clopidogrel treatment independently predicted a severe clinical condition and poor early and late prognosis in ischemic stroke patients.
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