Mi Sun Oh1, Kyung-Ho Yu2, Ju-Hun Lee2, San Jung2, Chulho Kim2, Min Uk Jang2, Juneyoung Lee2, Byung-Chul Lee1. 1. From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea. ssbrain@hallym.ac.kr iyyar@hallym.ac.kr. 2. From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea.
Abstract
OBJECTIVES: To investigate whether aspirin resistance is associated with initial stroke severity and infarct volume, using diffusion-weighted imaging (DWI) in patients with acute ischemic stroke that occurred while taking aspirin. METHODS: We studied a total of 310 patients who were admitted within 48 hours of acute ischemic stroke onset. All patients had been taking aspirin for at least 7 days before stroke onset. Aspirin resistance, defined as high residual platelet reactivity (HRPR) on aspirin treatment, was measured using the VerifyNow assay and defined as an aspirin reaction unit ≥550. Initial stroke severity was assessed using the NIH Stroke Scale (NIHSS) score. Infarct volume was measured using DWI. RESULTS: HRPR occurred in 86 patients (27.7%). The initial NIHSS score (median [interquartile range]) was higher in patients with HRPR than in the non-HRPR group (6 [3-15] vs 3 [1-8], p < 0.001). DWI infarct volumes were also larger in the HRPR group compared to the non-HRPR group (5.4 [0.8-43.2] vs 1.7 [0.4-10.3], p = 0.002). A multivariable median regression analysis showed that HRPR was significantly associated with an increase of 2.1 points on the NIHSS (95% confidence interval 0.8-4.0, p < 0.001) and an increase of 2.3 cm(3) in DWI infarct volume (95% confidence interval 0.4-3.9, p < 0.001). CONCLUSIONS: Aspirin resistance is associated with an increased risk of severe stroke and large infarct volume in patients taking aspirin before stroke onset.
OBJECTIVES: To investigate whether aspirin resistance is associated with initial stroke severity and infarct volume, using diffusion-weighted imaging (DWI) in patients with acute ischemic stroke that occurred while taking aspirin. METHODS: We studied a total of 310 patients who were admitted within 48 hours of acute ischemic stroke onset. All patients had been taking aspirin for at least 7 days before stroke onset. Aspirin resistance, defined as high residual platelet reactivity (HRPR) on aspirin treatment, was measured using the VerifyNow assay and defined as an aspirin reaction unit ≥550. Initial stroke severity was assessed using the NIH Stroke Scale (NIHSS) score. Infarct volume was measured using DWI. RESULTS: HRPR occurred in 86 patients (27.7%). The initial NIHSS score (median [interquartile range]) was higher in patients with HRPR than in the non-HRPR group (6 [3-15] vs 3 [1-8], p < 0.001). DWI infarct volumes were also larger in the HRPR group compared to the non-HRPR group (5.4 [0.8-43.2] vs 1.7 [0.4-10.3], p = 0.002). A multivariable median regression analysis showed that HRPR was significantly associated with an increase of 2.1 points on the NIHSS (95% confidence interval 0.8-4.0, p < 0.001) and an increase of 2.3 cm(3) in DWI infarct volume (95% confidence interval 0.4-3.9, p < 0.001). CONCLUSIONS:Aspirin resistance is associated with an increased risk of severe stroke and large infarct volume in patients taking aspirin before stroke onset.
Authors: Adam Wiśniewski; Joanna Sikora; Agata Sławińska; Karolina Filipska; Aleksandra Karczmarska-Wódzka; Zbigniew Serafin; Grzegorz Kozera Journal: J Clin Med Date: 2020-01-17 Impact factor: 4.241