Assessment of the relationship between platelet reactivity, vascular risk factors and gender in cerebral ischaemia patients
Abstract
Aim. Excessive activation and platelet aggregation play important roles in the aetiopathogenesis of cerebral ischaemia. The aim of this study was to assess the relationship between platelet reactivity, gender and vascular risk factors in cerebral ischaemia patients.
Clinical rationale for the study. The research is useful because we found high risk groups of inefficient aspirin treatment in cerebral ischaemia patients.
Material and methods. The study involved 101 patients, including 69 patients with ischaemic stroke and 32 patients with transient ischaemic attack. The assessment of platelet reactivity was made within 24 hours of the disease onset using two aggregometric methods: impedance and optical.
Results. Resistance to acetylsalicylic acid among people with cerebral ischaemia was estimated at 30.69% using impedance aggregometry and 9.2% using optical aggregometry. There were no differences in platelet reactivity or ASA resistance between the groups of patients with stroke and TIA in either method. In the whole group of patients (p = 0.04), and in the group of patients with stroke (p = 0.0143), higher reactivity of platelets was observed by impedance aggregometry in men than in women. In the whole group of patients (p = 0.0229), and in the subgroup with stroke (p = 0.0123), it was shown that aspirin resistance is significantly more common in the subgroup of men than in women. In patients suffering from nicotine addiction, significantly higher platelet reactivity was found in the whole group of patients (p = 0.004), as well as in the subgroup of patients with stroke (p = 0.0135).
Conclusions. There are no differences between platelet reactivity and the incidence of aspirin resistance in patients with stroke and TIA. Male gender and smoking are associated with greater reactivity of platelets and more frequent occurrence of acetylsalicylic acid resistance in patients with cerebral ischaemia.
Clinical implications. Dual antiplatelet therapy or clopidogrel treatment should be considered in smoking males with cerebral ischaemia due to the high risk of aspirin inefficiency.
Keywords: platelet reactivitystrokeaspirin resistancegenderrisk factors
References
- Naghavi M, Wang H, Lozano R. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385(9963): 117–171.
- Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(7): 2064–2089.
- Ahmed N, Steiner T, Caso V, et al. ESO-KSU session participants. Recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 13-15 November 2016. Eur Stroke J. 2017; 2(2): 95–102.
- Ozben S, Ozben B, Tanrikulu AM, et al. Aspirin resistance in patients with acute ischemic stroke. J Neurol. 2011; 258(11): 1979–1986.
- Paniccia R, Priora R, Liotta AA, et al. Platelet function tests: a comparative review. Vasc Health Risk Manag. 2015; 11: 133–148.
- Sibbing D, Braun S, Jawansky S, et al. Assessment of ADP-induced platelet aggregation with light transmission aggregometry and multiple electrode platelet aggregometry before and after clopidogrel treatment. Thromb Haemost. 2008; 99(1): 121–126.
- Tóth O, Calatzis A, Penz S, et al. Multiple electrode aggregometry: a new device to measure platelet aggregation in whole blood. Thromb Haemost. 2006; 96(6): 781–788.
- Englyst NA, Horsfield G, Kwan J, et al. Aspirin resistance is more common in lacunar strokes than embolic strokes and is related to stroke severity. J Cereb Blood Flow Metab. 2008; 28(6): 1196–1203.
- Kim JT, Heo SH, Lee JiS, et al. Aspirin resistance in the acute stages of acute ischemic stroke is associated with the development of new ischemic lesions. PLoS One. 2015; 10(4): e0120743.
- Cheng X, Xie NC, Xu HL, et al. Biochemical aspirin resistance is associated with increased stroke severity and infarct volumes in ischemic stroke patients. Oncotarget. 2017; 8(44): 77086–77095.
- Sobol A, Mochecka A, Selmaj K, et al. Is there a relationship between aspirin responsiveness and clinical aspects of ischemic stroke? Adv Clin Exp Med. 2009; 18(5): 473–479.
- Zheng ASY, Churilov L, Colley RE, et al. Association of aspirin resistance with increased stroke severity and infarct size. JAMA Neurol. 2013; 70(2): 208–213.
- El-Mitwalli A, Azzam H, Abu-Hegazy M, et al. Clinical and biochemical aspirin resistance in patients with recurrent cerebral ischemia. Clin Neurol Neurosurg. 2013; 115(7): 944–947.
- Lai PT, Chen SY, Lee YS, et al. Relationship between acute stroke outcome, aspirin resistance, and humoral factors. J Chin Med Assoc. 2012; 75(10): 513–518.
- Patti G, Polacco M, Taurino E, et al. Effects of cigarette smoking on platelet reactivity during P2Y12 inhibition in patients with myocardial infarction undergoing drug-eluting stent implantation: results from the prospective cigarette smoking on platelet reactivity (COPTER) study. J Thromb Thrombolysis. 2016; 41(4): 648–653.
- Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004; 43(10): 1731–1737.
- Blache D, Bouthillier D, Davignon J. Acute influence of smoking on platelet behaviour, endothelium and plasma lipids and normalization by aspirin. Atherosclerosis. 1992; 93(3): 179–188.
- Rollini F, Franchi F, Cho JR, et al. Cigarette smoking and antiplatelet effects of aspirin monotherapy versus clopidogrel monotherapy in patients with atherosclerotic disease: results of a prospective pharmacodynamic study. J Cardiovasc Transl Res. 2014; 7(1): 53–63.
- Järemo P, Eriksson-Franzen M, Milovanovic M. Platelets, gender and acute cerebral infarction. J Transl Med. 2015; 13: 267.
- Oh MiS, Yu KH, Lee JH, et al. Aspirin resistance is associated with increased stroke severity and infarct volume. Neurology. 2016; 86(19): 1808–1817.
- Kim JT, Heo SH, Choi KH, et al. Clinical Implications of Changes in Individual Platelet Reactivity to Aspirin Over Time in Acute Ischemic Stroke. Stroke. 2015; 46(9): 2534–2540.
- Ajayi AA, Mathur R, Halushka PV. Testosterone increases human platelet thromboxane A2 receptor density and aggregation responses. Circulation. 1995; 91(11): 2742–2747.
- Feuring M, Christ M, Roell A, et al. Alterations in platelet function during the ovarian cycle. Blood Coagul Fibrinolysis. 2002; 13(5): 443–447.
- Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009; 40(4): 1082–1090.
- Arboix A, Cartanyà A, Lowak M, et al. Gender differences and woman-specific trends in acute stroke: results from a hospital-based registry (1986-2009). Clin Neurol Neurosurg. 2014; 127: 19–24.
- Becker DM, Segal J, Vaidya D, et al. Sex differences in platelet reactivity and response to low-dose aspirin therapy. JAMA. 2006; 295(12): 1420–1427.
- Paniccia R, Antonucci E, Maggini N, et al. Assessment of platelet function on whole blood by multiple electrode aggregometry in high-risk patients with coronary artery disease receiving antiplatelet therapy. Am J Clin Pathol. 2009; 131(6): 834–842.
- McCabe DJH, Harrison P, Mackie IJ, et al. Assessment of the antiplatelet effects of low to medium dose aspirin in the early and late phases after ischaemic stroke and TIA. Platelets. 2005; 16(5): 269–280.
- Wang CW, Su LL, Hua QJ, et al. Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients. Brain Res Bull. 2018; 142: 176–182.
- Fiolaki A, Katsanos AH, Kyritsis AP, et al. High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke: A systematic review and meta-analysis. J Neurol Sci. 2017; 376: 112–116.
