Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2009, vol. 18, nr 5, September-October, p. 473–479

Publication type: original article

Language: English

Is There a Relationship Between Aspirin Responsiveness and Clinical Aspects of Ischemic Stroke?

Czy istnieje związek między odpowiedzią na aspirynę a klinicznymi aspektami udaru niedokrwiennego mózgu

Anna B. Sobol1,, Alina Mochecka2,, Krzysztof Selmaj2,, Jerzy Loba1,

1 Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Poland

2 Department of Neurology, Medical University of Lodz, Poland

Abstract

Background. The issue of aspirin responsiveness in ischemic stroke patients is still unresolved.
Objectives. The aim of the study was to determine whether aspirin responsiveness is related to the clinical status of stroke.
Material and Methods. Platelet response to acetylsalicylic acid (ASA) was assessed in 64 patients (41 men, mean age: 57.9 ± 10.4 years) with ischemic stroke or transient ischemic attack receiving the routine dose of 150 mg of ASA daily. Platelet reactivity was assessed using a platelet function analyzer (PFA−100) with collagen/epinephrine cartridges and by whole−blood platelet aggregometry with 0.5 mM arachidonic acid on the first day of acute stroke and after 10 days of ASA intake.
Results. Of the 64 patients, 23 (36%) were ASA unresponsive as assessed by the platelet reactivity tests. Based on the Rankin Scale (of 1–5), significantly worse neurological status was observed in the group of grade−3 ASA−unresponsive compared with grade−2 ASA−responsive patients 10 days after stroke occurrence (p = 0.02). In all the ASA−unresponsive patients, clinical worsening and/or computed tomography signs of progression before modification of the antiplatelet and/or antithrombotic treatment were observed.
Conclusion. These findings suggest that assessment of ASA response might be a predictive factor in stroke prognosis and therapy.

Streszczenie

Wprowadzenie. Problem odpowiedzi na aspirynę u pacjentów z niedokrwiennym udarem mózgu pozostaje przedmiotem dyskusji.
Cel pracy. Zbadanie, czy odpowiedź na aspirynę jest związana z klinicznym przebiegiem niedokrwiennego udaru mózgu.
Materiał i metody. Oceniano reakcję płytek krwi na kwas acetylosalicylowy (ASA) u 64 pacjentów (41 M, średnia wieku 57,9 ± 10,4 lat) z niedokrwiennym udarem mózgu lub przejściowym atakiem niedokrwiennym (TIA), otrzymujących rutynową dawkę ASA dziennie. Reaktywność płytek krwi oceniano za pomocą analizatora czynności płytek krwi (PFA−100TM) z użyciem kartridży kolagen/epinefryna i na podstawie pomiaru agregacji we krwi pełnej z 0,5 mM kwasem arachidonowym w pierwszym dniu wystąpienia udaru i po 10 dniach przyjmowania 150 mg ASA.
Wyniki. Wśród 64 pacjentów – 23 (36%) nie wykazywało odpowiedzi na ASA na podstawie oceny reaktywności płytek. Zgodnie z oceną neurologiczną według skali Rankina, po 10 dniach trwania udaru obserwowano statystycznie istotny gorszy stan neurologiczny w grupie pacjentów nieodpowiadających na ASA 3 (1–5) w porównaniu z grupą pacjentów z prawidłową odpowiedzią na ASA 2 (1–5) (p = 0,02). U wszystkich pacjentów nieodpowiadających na ASA obserwowano kliniczne pogorszenie i/lub cechy progresji w badaniu tomografii komputerowej przed modyfikacją leczenia przeciwpłytkowego lub przeciwzakrzepowego.
Wnioski. Badania własne sugerują, że ocena odpowiedzi na ASAmoże być czynnikiem predykcyjnym w rokowaniu i leczeniu udaru mózgu.

Key words

acetylsalicylic acid, antiplatelet therapy, aspirin responsiveness, ischemic stroke

Słowa kluczowe

kwas acetylosalicylowy, leczenie przeciwpłytkowe, niedokrwienny udar mózgu, odpowiedź na aspirynę

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