title: Acute hemorrhagic complications are associated with lower coated-platelet levels in non-lacunar brain infarction.
abstract: BACKGROUND
  Coated platelets are procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with non-lacunar ischemic stroke and decreased in patients with spontaneous intracerebral hemorrhage as compared with controls.
  
  
  OBJECTIVE
  To investigate whether acute hemorrhagic complications occurring during the initial hospital admission for non-lacunar ischemic stroke are associated with lower coated-platelet levels.
  
  
  METHODS
  Coated-platelet levels were determined in 385 consecutive patients with non-lacunar stroke. Hemorrhagic complications were defined as either intracranial hemorrhage or significant extracranial bleeding (drop in hemoglobin of ≥ 2 g dL(-1) ). The rate of acute hemorrhagic complication was compared among subjects categorized into tertiles of coated-platelet levels using an exact Cochrane-Armitage trend test. Logistic regression was used to estimate the adjusted odds of hemorrhagic complication associated with coated-platelet levels.
  
  
  RESULTS
  Hemorrhagic complications were present in 15 (3.9%) cases. Of these, four had intracranial hemorrhage and 11 had extracranial hemorrhage. The occurrence of hemorrhagic complications differed among the coated-platelet tertiles: 10.2% for the first tertile (coated-platelet levels < 35.5%), 1.5% for the second tertile and 0% for the third tertile (coated-platelet levels ≥ 47.5%, trend test). Logistic regression showed that the odds of hemorrhagic complication in those with levels < 35.5% were 14.59 times the odds for patients with levels ≥ 35.5% (95% CI: 3.24-65.7).
  
  
  CONCLUSIONS
  Lower levels of procoagulant platelets are associated with acute hemorrhagic complications following non-lacunar ischemic stroke. These results suggest a role for coated-platelets in risk/benefit assessment in the early stages of stroke.
authors.affiliation: Department of Neurology, University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Oklahoma City, OK, USA.|University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Oklahoma City, OK, USA.
authors.forename: C I
authors.initials: CI
authors.lastname: Prodan
authors.affiliation: Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Stoner
authors.affiliation: Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Dale
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D001792:Blood Platelets / Q000378:metabolism*; D020520:Brain Infarction / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D015539:Platelet Activation; D010976:Platelet Count; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: blood platelets; brain infarction; hemorrhage; stroke; thrombosis