Adenosine diphosphate-induced platelet aggregation might contribute to poor outcomes in atrial fibrillation-related ischemic stroke

J Stroke Cerebrovasc Dis. 2014 Mar;23(3):e215-20. doi: 10.1016/j.jstrokecerebrovasdis.2013.10.011. Epub 2013 Nov 22.

Abstract

Systemic atherosclerosis is involved in ischemic damages and cardioembolism after atrial fibrillation (AF)-related ischemic stroke (IS). Platelet activation is a critical factor in systemic atherosclerosis; however, there is little information regarding the role of platelet activation on the outcome of AF-related IS. We investigated the relationship between adenosine diphosphate (ADP)-induced platelet aggregation and the long-term outcomes of AF-related IS. We studied 249 patients who were exclusively treated with anticoagulation therapy after they had experienced AF-related IS. We evaluated their platelet function 5 days after admission to the hospital by using an optic platelet aggregometer test. We also assessed the prognoses of patients 90 days after the AF-related IS. Our results showed that ADP-induced platelet aggregation was positively correlated with CHA2DS2-VASc scores (r = .285, P < .01). Totally, 107 (43.0%) patients had a poor outcome at 90 days after IS. Univariate analysis showed that the following factors significantly contribute to a poor outcome: older age (odds ratio [OR] = 1.07, confidence interval [CI] 1.04-1.10, P < .01), a history of stroke (OR = 3.24, CI 1.61-6.53, P < .01), high scores on the National Institutes of Health Stroke Scale (NIHSS; OR = 1.25, CI 1.18-1.32, P < .01), increased white blood cell counts (OR = 1.12, CI 1.02-1.24, P < .01), high CHA2DS2-VASc scores (≥5, OR = 7.31, CI 3.36-15.93, P = .025), and the highest tertile of ADP-induced platelet aggregation (≥72%, OR = 3.17, CI 1.67-5.99, P < .01). Of these factors, high NIHSS scores (OR = 1.27, CI 1.20-1.36, P < .01), high CHA2DS2-VASc scores (OR = 4.69, CI 1.21-18.14, P = .03), and the highest tertile of ADP-induced platelet aggregation (OR = 2.49, CI 1.17-5.27, P = .02) were independently associated with a poor outcome at 90 days after IS. Therefore, our results suggest that platelet activation might affect the outcome of AF-related IS.

Keywords: Platelet aggregation; adenosine diphosphate; atrial fibrillation; ischemic stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Diphosphate*
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / blood*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy
  • Brain Ischemia / blood*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology
  • Brain Ischemia / prevention & control
  • Chi-Square Distribution
  • Disability Evaluation
  • Female
  • Hospitalization
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Odds Ratio
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Aggregation* / drug effects
  • Platelet Function Tests*
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnosis
  • Stroke / drug therapy
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Adenosine Diphosphate