title: High residual platelet reactivity (HRPR) for adenosine diphosphate (ADP) stimuli is a determinant factor for long-term outcomes in acute ischemic stroke with anti-platelet agents: The meaning of HRPR after ADP might be more prominent in large atherosclerotic infarction than other subtypes of AIS.
abstract: High residual platelet activation (HRPA) after ADP stimuli has associated with recurrent vascular events in acute atherothrombosis with the use of antiplatelet agents (APAs). However, there has been little evidence supporting this association in acute ischemic stroke (AIS). In this study, we evaluated the influences of HRPR after ADP stimuli on the 1-year incidence of recurrent cardiovascular events and mortality in AIS with APAs. We conducted an observational, referral center cohort study on 968 AIS patients with APAs from January 2010 to December 2013 who were evaluated using optical platelet aggregometry (OPA). All patients received the dual APA combination of aspirin and clopidogrel or aspirin alone. We evaluated their platelet function 5 days after hospital admission using OPA. HRPR after ADP stimuli was defined as platelet aggregation of 70 % or greater according to OPA after 10 µM ADP stimuli. The primary endpoint was a composite of all causes of death, myocardial infarction, and stroke at the 1-year follow-up. The secondary endpoints were each component of the primary endpoint. The event rate of primary endpoint was 11.3 % (109/968). Its rate was significantly higher in the patients with HRPR (16.7 %) than in those without (9.7 %). HPRP was independently associated with the primary endpoint (OR = 1.97, CI 1.22-3.18, p < 0.01). According to the AIS subtype, the presence of HRPR was independently significant for the occurrence of the primary endpoint in the large artery atherosclerosis (LAA) subtype only (OR = 2.26, CI 1.15-4.45, p = 0.02). In this study, the presence of HRPR after ADP stimuli is associated with a poor long-term outcome after acute ischemic stroke. In particular, the influence of this factor might be more prominent in LAA compared with other types of AIS.
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea. nrcjk65@gmail.com.|Department of Neurology, Stroke Center, Dong-A University Hospital, 3-1 Ga, Dongdaeshin-Dong, Busan, 602-715, Republic of Korea. nrcjk65@gmail.com.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Hyun-Seok
authors.initials: HS
authors.lastname: Park
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Hyun-Wook
authors.initials: HW
authors.lastname: Nah
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Myong-Jin
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Busan-Ulsan Regional Cardio-Cerebral Vascular Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Jae-Taeck
authors.initials: JT
authors.lastname: Huh
authors.affiliation: Department of Visual optics, KyungWoon University, Gumi, Republic of Korea.
authors.forename: Hyun-Kyung
authors.initials: HK
authors.lastname: Suh
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology*; D050197:Atherosclerosis / Q000473:pathology; D002545:Brain Ischemia / Q000097:blood*; D015331:Cohort Studies; D023381:Endpoint Determination; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000244:Adenosine Diphosphate
keywords: Acute ischemic stroke; Aspirin; Clopidogrel; Platelet aggregation