Interest of Antiplatelet Drug Testing after an Acute Ischemic Stroke.

Abstract

BACKGROUND Stroke occurrence despite chronic antiplatelet drug (APD) treatment is frequent. We aimed at evaluating the relevance of platelet aggregation testing in the identification of stroke etiology in this context. METHODS Patients admitted for a suspected acute ischemic stroke, while under APD (aspirin and/or clopidogrel), were prospectively included. The efficacy of the APD was evaluated using a Multiplate™ assay. Resistance was confirmed using light transmission aggregometry. A standardized diagnostic work-up was performed to identify stroke mechanism according to the TOAST and the ASCO classifications. We evaluated the influence of APD functional status on stroke severity and identified potential determinants of resistance. RESULTS APD resistance was observed in 53 of the 287 patients (18.5%). No difference in stroke mechanism depending on APD efficacy was observed. Patients sensitive to APD had less severe initial stroke severity (mean National Institutes of Health Stroke Scale 3.9 ± 5.6 vs. 7.2 ± 6.8; p < 0.01). Main determinants for APD resistance were a worse control of the diabetes and higher baseline levels of inflammation (mean CRP 26.4 ± 56.0 vs. 9.3 ± 21.0; p < 0.01). CONCLUSIONS Platelet function testing does not provide orientation concerning stroke mechanism in patients who were previously on APDs. However, the high frequency of APD resistance and its association with inflammation and stroke severity are confirmed.

DOI: 10.1159/000438722

Cite this paper

@article{Coignion2015InterestOA, title={Interest of Antiplatelet Drug Testing after an Acute Ischemic Stroke.}, author={Cyrielle Coignion and Mathilde Poli and Sharmila Sagnier and Genevi{\`e}ve Freyburger and Pauline Renou and Sabrina Debruxelles and François Rouanet and Igor Sibon}, journal={European neurology}, year={2015}, volume={74 3-4}, pages={135-9} }