Platelet Function Tests Predicting the Efficacy and Safety of Aspirin Secondary Prevention

ABSTRACT

Objective

To precisely prevent stroke, we evaluated three platelet function tests and their associations with clinical outcomes in ischemic stroke patients.

Methods

On-treatment platelet reactivity of acute minor stroke patients taking aspirin plus clopidogrel was tested by light transmittance aggregometry (LTA), thromboelastography (TEG) and platelet function analyzer (PFA). Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis were used to assess their associations with recurrent events and clinical outcome prediction.

Results

127 acute minor stroke patients were stringently selected and followed for 13 months. Eight patients (6.3%) self-reported the recurrence and 13 (10.2%) patients self-reported bleeding. Recurrent patients displayed significantly higher on-treatment platelet reactivity when measured with LTA (p = 0.030) and PFA (p < 0.001). Further ROC analysis demonstrated that LTA and PFA had modest-to-fair ability to predict stroke recurrence (LTA: area under the curve [AUC], 0.765; 95% CI, 0.584–0.945, PFA: AUC, 0.832; 95% CI, 0.658–1.000). However, TEG (measured by the platelet inhibition rate) could not detect the difference between recurrent patients and non-recurrent patients (p = 0.515) and predict recurrent events (AUC, 0.569; 95% CI, 0.368–0.770). None of the tests were associated with bleeding except for PFA (p < 0.001), with AUC of PFA reaching 0.772 (0.726–0.818).

Conclusions

Of the three tests assessed, the predictive accuracies of PFA and LTA were satisfying for aspirin secondary prevention, while TEG’s performance was poor. Only PFA could provide accurate prognostic information for bleeding.

KEYWORDS:

• Platelet function tests
• ischemic stroke
• secondary prevention

Data availability statement

All data used during the study are available by request to the corresponding author via e-mail ([email protected]).

Contributorship statement

Y.X. and M.Z. conceived, designed, coordinated the study, and revised the manuscript; Y.C. analyzed the data and wrote the manuscript. T.S. and W.G. collected data. L.H., D.Y., H.X., and P.S. helped with patient enrolling and blood sample collection. All authors revised the manuscript for important intellectual content critically.

Additional information

Funding

This research was supported by the Key Research and Development Program of Jiangsu Province of China (no. BE2020620 to Dr. Xu), the National Natural Science Foundation of China (nos. 81920108017 and 81630028 to Dr. Xu, no. 81971112 to Dr. Zhang), the National Key Research and Development Program of China (no. 2016YFC1300504 to Dr. Xu), Hengrui Hospital Pharmacy foundation of Jiangsu Pharmaceutical Association (no. H202006), Jiangsu Research Hospital Association for Precision Medication (no. JY202014).

Notes on contributors

Yue Cheng

Yue Cheng is a research assistant in Department of Neurology in Affiliated Drum Tower Hospital. She received her Master degree in Nanjing Medical University. She specializes in data processing and biostatistics.

Tengfei Shao

Tengfei Shao, pharmacist-in-charge, has been focusing his research on antiplatelet treatment for 5 years. He graduated from Fudan university with a master degree.

Lili Huang

Lili Huang is a doctoral student in Nanjing University Medical School. She focuses on clinical research on cerebrovascular diseases and cognitive impairment.

Hengheng Xu

Hengheng Xu is a full-time graduate student in Nanjing University Medical School. He is good at neuro-imaging and data analysis.

Pengfei Shao

Pengfei Shao is a full-time graduate student in Nanjing University Medical School focusing on clinical research on cerebrovascular diseases.

Dan Yang

Dan Yang is a physician at Nanjing Drum Tower Hospital. She graduated from Southeast University with a master degree in neurology.

Weihong Ge

Weihong Ge is a chief pharmacist and the chief director of Department of Pharmacy. She is responsible for drug evaluation studies.

Yun Xu

Yun Xu is chief director of Department of Neurology in Affiliated Drum Tower Hospital. She is the professor at Nanjing University, Nanjing Medical University Her specialties include basic research of cerebrovascular diseases and both basic and clinical research on cognitive impairment.

Meijuan Zhang

Meijuan Zhang received the PhD degree in Nanjing University Medical School majoring in neurology. She is an associate chief of neurology in Nanjing Drum Tower Hospital. Her main research interests include mechanism research of stroke and clinical research on stroke.