Angelia C Kirkpatrick1,2, Andrea S Vincent3, George L Dale1, Calin I Prodan2,4. 1. Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 2. Veterans Affairs Medical Center, Oklahoma City, OK, USA. 3. Cognitive Science Research Center, University of Oklahoma, Norman, OK, USA. 4. Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Abstract
BACKGROUND: Mean levels of coated-platelets, a subset of highly procoagulant platelets, are decreased in patients with lacunar as compared to those with non-lacunar stroke. Elevated coated-platelets are associated with increased risk for recurrent infarction in non-lacunar stroke and predict incident stroke after transient ischemic attack (TIA). OBJECTIVE: We investigated if coated-platelet levels are predictive of recurrent cerebral ischemia following lacunar stroke. METHODS: Coated-platelet levels were assayed in consecutive patients with acute lacunar stroke, who were followed for up to 12 months. Cox proportional hazards regression analysis was used to estimate the combined risk of stroke and TIA at 12 months according to initial coated-platelet levels. RESULTS: We enrolled a total of 109 lacunar stroke patients. Eight events were recorded over a mean follow-up period of 10.8 months. A cut-off of 42.6% for coated-platelet levels yielded a sensitivity of 0.75 (0.35-0.97; 95% confidence interval [CI]), specificity of 0.92 (0.85-0.97), positive predictive value of 0.43 (0.26-0.62), and a negative predictive value of 0.98 (0.93-0.99) for recurrent stroke/TIA. The adjusted hazard ratio for recurrent stroke/TIA in patients with coated-platelet levels ≥ 42.6% was 23.9 (95% CI: 4.26-134.4) when compared to those with levels < 42.6%. CONCLUSIONS: Identification of increased platelet procoagulant potential may improve our ability to identify patients at higher risk of recurrent stroke/TIA following a lacunar stroke. Further study of mechanisms involved is warranted and may yield novel targets for prevention and treatment.
BACKGROUND: Mean levels of coated-platelets, a subset of highly procoagulant platelets, are decreased in patients with lacunar as compared to those with non-lacunar stroke. Elevated coated-platelets are associated with increased risk for recurrent infarction in non-lacunar stroke and predict incident stroke after transient ischemic attack (TIA). OBJECTIVE: We investigated if coated-platelet levels are predictive of recurrent cerebral ischemia following lacunar stroke. METHODS: Coated-platelet levels were assayed in consecutive patients with acute lacunar stroke, who were followed for up to 12 months. Cox proportional hazards regression analysis was used to estimate the combined risk of stroke and TIA at 12 months according to initial coated-platelet levels. RESULTS: We enrolled a total of 109 lacunar strokepatients. Eight events were recorded over a mean follow-up period of 10.8 months. A cut-off of 42.6% for coated-platelet levels yielded a sensitivity of 0.75 (0.35-0.97; 95% confidence interval [CI]), specificity of 0.92 (0.85-0.97), positive predictive value of 0.43 (0.26-0.62), and a negative predictive value of 0.98 (0.93-0.99) for recurrent stroke/TIA. The adjusted hazard ratio for recurrent stroke/TIA in patients with coated-platelet levels ≥ 42.6% was 23.9 (95% CI: 4.26-134.4) when compared to those with levels < 42.6%. CONCLUSIONS: Identification of increased platelet procoagulant potential may improve our ability to identify patients at higher risk of recurrent stroke/TIA following a lacunar stroke. Further study of mechanisms involved is warranted and may yield novel targets for prevention and treatment.
Authors: Mohamad H Khattab; Calin I Prodan; Andrea S Vincent; Chao Xu; Kellie R Jones; Sharanjeet Thind; Meheroz Rabadi; Shubhada Mithilesh; Eleanor Mathews; Leslie Guthery; George L Dale; Angelia C Kirkpatrick Journal: Geroscience Date: 2021-06-09 Impact factor: 7.713
Authors: Muataz Ali Hamad; Krystin Krauel; Nancy Schanze; Nadine Gauchel; Peter Stachon; Thomas Nuehrenberg; Mark Zurek; Daniel Duerschmied Journal: Front Cardiovasc Med Date: 2022-04-07
Authors: Christine S M Lee; Maria V Selvadurai; Leonardo Pasalic; James Yeung; Maria Konda; Geoffrey W Kershaw; Emmanuel J Favaloro; Vivien M Chen Journal: J Thromb Haemost Date: 2022-02-07 Impact factor: 16.036