title: Aspirin non-responder status and early neurological deterioration: a prospective study.
abstract: OBJECTIVE
  In acute ischemic stroke, early neurological deterioration (END) has a severe impact on patient outcome. We tested the hypothesis that initial biological aspirin non-responder status (ANRS) helps predict END.
  
  
  METHODS
  A total of 85 patients with acute ischemic stroke on 160mg aspirin daily were prospectively included. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥4 points in the first 72h after admission. Platelet responsiveness to aspirin was assessed using the PFA-100 system, and ANRS was defined as a collagen/epinephrine closure time <165ms.
  
  
  RESULTS
  END was observed in 10 patients (11.8%). The presumed reasons for END were progressive stroke (40%), recurrent cerebral ischemia (30%), malignant middle cerebral artery infarction (20%) and secondary acute hydrocephalus (10%). Patients with END had a non-significant worse neurological status on the NIHSS at hospital admission (8.4 vs. 4.2; p=0.15). Initial impaired consciousness (30% vs. 3%), visual disturbance (60% vs. 23%) and ANRS (60% vs. 20%) were observed more frequently in patients with END. In multivariate analysis, impaired consciousness (OR: 17.3; 95% CI: 2.0-149.5; p=0.01) and ANRS (OR: 6.4; 95% CI: 1.4-29.6; p=0.017) were found to be independently associated with END.
  
  
  CONCLUSIONS
  ANRS is common in acute ischemic stroke patients and is predictive of END. The clinical significance of these findings requires further evaluation in larger longitudinal studies.
authors.affiliation: Department of Neurology, Amiens University Hospital, and Laboratoire de Neurosciences Fonctionnelles et Pathologies, Place V Pauchet, 80000 Amiens, France. bugnicourt.jean-marc@chu-amiens.fr
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Bugnicourt
authors.forename: Bertrand
authors.initials: B
authors.lastname: Roussel
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Garcia
authors.forename: Sandrine
authors.initials: S
authors.lastname: Canaple
authors.forename: Chantal
authors.initials: C
authors.lastname: Lamy
authors.forename: Olivier
authors.initials: O
authors.lastname: Godefroy
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000473:pathology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin