November 7, 2017OncotargetOpen Access

Platelet function-guided modification in antiplatelet therapy after acute ischemic stroke is associated with clinical outcomes in patients with aspirin nonresponse

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke with aspirin nonresponse (n=812). Intervention: Platelet function-guided modification in antiplatelet therapy vs. No modification in antiplatelet therapy. Primary outcome: Ischemic events (ischemic stroke, transient ischemic attack, or myocardial infarction) (HR 0.67, 95% CI 0.62-0.97, p=0.01).

View Full Paper

Ask AI

Bookmark

Key result

In patients with aspirin nonresponse, platelet function-guided modification in antiplatelet therapy significantly reduced the risk of ischemic events (HR 0.67) compared with no modification.

Why the study?

Does platelet function-guided modification in antiplatelet therapy reduce ischemic events in patients with acute ischemic stroke and aspirin nonresponse?

Population

812 patients with first-ever ischemic stroke admitted within 72 hours of onset, receiving aspirin…

Comparison

Antiplatelet therapy modification guided by… vs No modification in antiplatelet therapy.

Design

Cohort, Researchers who performed follow-up interviews were blinded to aspirin…

Follow-up

mean 4.8 ± 1.7 years

Authors

XYXingyang YiDeyang Stomatological Hospital JLJing LinGuilin Medical University CWChun WangLanzhou Institute of Chemical Physics

Discussion

Member takes

Implication

May support guided modification in aspirin nonresponders after stroke; leaves open confirmation by randomized trials.

Study Design

Type

Cohort (n=812)

Multicenter

Yes

Structured PICO

Does platelet function-guided modification in antiplatelet therapy reduce ischemic events in patients with acute ischemic stroke and aspirin nonresponse?

Population

812 patients (age ≥ 40 years) with first-ever ischemic stroke admitted within 72 hours of onset, receiving aspirin monotherapy before platelet function testing. Excluded patients with cerebral embolism or undetermined etiologies.

Intervention

Antiplatelet therapy modification (ATM) guided by platelet function testing (changing from aspirin to clopidogrel or cilostazol, adding clopidogrel to aspirin, or increasing aspirin dosage).

Comparator

No modification in antiplatelet therapy (continued aspirin 100 mg/day).

Outcome

Ischemic events (composite of ischemic stroke, transient ischemic attack, or myocardial infarction).composite

Main Result

Effect estimate: HR 0.67 (95% CI 0.62-0.97)

Absolute Event Rate: 18.2% vs 33.3%

p-value: p=0.01

Platelet function-guided modification of antiplatelet therapy significantly reduces ischemic events in patients with acute ischemic stroke who exhibit aspirin nonresponse.

Limitations

Retrospective and observational design may introduce selection bias and limit generalizability.
Diverse modifications in antiplatelet regimens were at the physician's discretion without standardized protocols.
Platelet aggregation was only measured using light transmittance aggregometry (LTA).
Infrequency of retesting platelet function after therapy modification limited the ability to determine if responsiveness resulted in clinical benefit.
Relatively small sample size across only three centers.
Unknown confounders may have contributed to the differences in clinical outcomes despite propensity score adjustment.
Retrospective, non-randomized design
Diverse modifications in antiplatelet regimens were at the discretion of the treating physician due to lack of standardized recommendations

Cite This Study

Yi et al. (2017) conducted a cohort in Acute ischemic stroke with aspirin nonresponse (n=812). Platelet function-guided modification in antiplatelet therapy vs. No modification in antiplatelet therapy was evaluated on Ischemic events (ischemic stroke, transient ischemic attack, or myocardial infarction) (HR 0.67, 95% CI 0.62-0.97, p=0.01). In patients with aspirin nonresponse, platelet function-guided modification in antiplatelet therapy significantly reduced the risk of ischemic events (HR 0.67) compared with no modification.

synapsesocial.com/papers/6a12ecd645487b7639a76700 https://doi.org/10.18632/oncotarget.22293

Topics

Dual antiplatelet therapy

View Full Paper

Ask AI

Bookmark

Platelet function-guided modification in antiplatelet therapy after acute ischemic stroke is associated with clinical outcomes in patients with aspirin nonresponse

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Platelet function-guided modification in antiplatelet therapy after acute ischemic stroke is associated with clinical outcomes in patients with aspirin nonresponse

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider