Assessment of Platelet Function in Acute Ischemic Stroke Patients Previously Treated with Aspirin

Fecha de publicación: 01/11/2014

Autores de IIS La Fe

Aida Lago Martín

Autor
Vera Parkhutik Matveeva

Autor
José Ignacio Tembl Ferrairo

Autor
Juana Valles Giner

Autor
Maria Teresa Santos Diaz

Autor
Antonio Moscardó Martínez

Autor

Grupos

Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

Investigador Principal

Pilar Medina Badenes

Abstract

Background: Platelet inhibition measured by platelet function tests could be critical to understand the reasons for early recurrence and to guide therapeutic recommendations. We assess the platelet function during the acute phase of ischemic stroke in patients pretreated with aspirin who continue their treatment with aspirin only, are started on clopidogrel only, or add clopidogrel to aspirin. Methods: Sixty-four patients were taking aspirin before the stroke. Depending on the administered antiplatelet, 3 groups were defined: ASA: patients who continued on aspirin orally or intravenous acetylsalicylate of lysine, n = 30; CLO: patients who discontinued aspirin and were started on clopidogrel, n = 16; and ASA + CLO: patients who were prescribed both aspirin and clopidogrel, n = 10. Collagen-induced thromboxane A(2) (TXA(2)) synthesis, ADP (adenosine diphosphate)-induced aggregation, and occlusion time (PF-100) were measured. Results: CLO group only had a marked elevation of TXA(2) (17.44 +/- 15.62 ng/mL, P = .000) and a shortening of the platelet function analyzer (PFA)-100 closure time (157.13 +/- 88 seconds, P = .047) compared with the other 2 groups (ASA: TXA(2), .62 +/- 1.59 ng/mL; ASA + CLO: TXA(2) 1.79 +/- 4.59 ng/mL). They achieved a small (13%) but significant reduction of ADP-induced aggregation (87.00 +/- 23.06 mm, P = .008) compared with the ASA group (102.82 +/- 22.38 seconds). Conclusions: Stopping aspirin intake within the first 72 hours of the acute stroke drastically increases TXA(2) synthesis. During the same time window, the freshly prescribed clopidogrel manages to reduce the ADP-induced aggregation only slightly (13%). This study offers analytic proof that the common practice of replacing aspirin with clopidogrel does not leave stroke patients fully protected during the first days after an ischemic stroke. Possible solutions could be to preserve aspirin during a few days or to use loading doses of clopidogrel at hospital admission.

Datos de la publicación

ISSN/ISSNe:: 1052-3057, 1532-8511
Tipo:: Article
Páginas:: 2794-2799
DOI:: 10.1016/j.jstrokecerebrovasdis.2014.07.007
Factor de Impacto:: 0,843 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Lago A:: Department of Neurology, Hospital Universitari La Fe, Valencia, Spain.
Parkhutik V:: Department of Neurology, Hospital Universitari La Fe, Valencia, Spain
Tembl JI:: Department of Neurology, Hospital Universitari La Fe, Valencia, Spain
Vallés J:: Instituto de Investigación. Research Center, Hospital Universitari La Fe, Valencia, Spain
Santos MT:: Instituto de Investigación. Research Center, Hospital Universitari La Fe, Valencia, Spain
Moscardó A:: Instituto de Investigación. Research Center, Hospital Universitari La Fe, Valencia, Spain

Keywords

Antiplatelet; ischemic stroke; aspirin; clopidogrel

Proyectos asociados

INVESTIGACION EN RED DE LAS ENFERMEDADES NEUROLOGICAS

Investigador Principal: JUAN JESÚS VÍLCHEZ PADILLA

C03/06 . INSTITUTO DE SALUD CARLOS III . 2003

AVANCES EN EL ESTUDIO DE LA REACTIVIDAD PLAQUETARIA Y SU INTERACCION CON LOS ERITROCITOS: BASES MOLECUALRES Y APLICABILIDAD CLINICO-FARMACOLOGICA

Investigador Principal: JUANA VALLES GINER

PI03/0270 . INSTITUTO DE SALUD CARLOS III . 2004

RED DE INVESTIGACION (RENEVAS)

Investigador Principal: ENRIQUE ALBORCH DOMÍNGUEZ

RD06/0026/0006 . INSTITUTO DE SALUD CARLOS III; FUNDACIÓN INSTITUTO DE INVESTIGACIÓN SANITARIA DE SANTIAGO DE COMPOSTELA (FIDIS); FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006