Key result
Larger CEPI closure time prolongation linked to ~11.9-fold higher odds of favorable stroke recovery.
Why the study?
Antiplatelet agents reduce recurrent stroke risk, but identifying nonresponders remains a clinical challenge, leading investigators to evaluate whether point-of-care platelet function tests could predict favorable outcomes in acute ischemic stroke.
Does serial platelet function assessment using PFA-100 predict functional recovery in patients with acute ischemic stroke?
Cohort (n=212)
No
Does serial platelet function assessment using PFA-100 predict functional recovery in patients with acute ischemic stroke?
Odds Ratio: 11.859 (95% CI 2.318–60.669)
p-value: p=0.003
Serial evaluation of platelet function using PFA-100, specifically changes in CEPI closure time over 2 weeks, can predict early and late favorable functional outcomes in acute ischemic stroke patients on aspirin therapy.
Serial CEPI changes may aid prognostication after ischemic stroke; leaves open whether testing should guide therapy.
Background: 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. Methods: 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. Results: Difference in collagen and epinephrine (CEPI) measurements between baseline and week 2 was associated with favorable mRS scores (p < 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 (p = 0.007). Conclusions: 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.
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Ho et al. (2024) conducted a cohort in Acute Ischemic Stroke (n=212). Difference in CEPI closure time > 99 seconds (baseline to week 2) vs. Lower changes in CEPI closure time (lower quartiles) was evaluated on Favorable functional recovery, defined by a modified Rankin Scale (mRS) score of 0-3 at 1-month follow-up (adjusted OR 11.859, 95% CI 2.318-60.669, p=0.003). A difference in CEPI closure time greater than 99 seconds between baseline and week 2 strongly predicted favorable functional recovery at 1 month in acute ischemic stroke patients (adjusted OR 11.859).
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