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Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report

Background: Platelet function testing is a valid tool to investigate the clinical response to antiplatelet therapy in different clinical settings; in particular, it might supply helpful information in patients with cerebrovascular disease. Oral antiplatelet treatment, such as Aspirin (ASA) and Clopi...

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Autores principales: Rosafio, Francesca, Bigliardi, Guido, Lelli, Nicoletta, Vandelli, Laura, Naldi, Federica, Ciolli, Ludovico, Meletti, Stefano, Zini, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383200/
https://www.ncbi.nlm.nih.gov/pubmed/34447344
http://dx.doi.org/10.3389/fneur.2021.663308
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author Rosafio, Francesca
Bigliardi, Guido
Lelli, Nicoletta
Vandelli, Laura
Naldi, Federica
Ciolli, Ludovico
Meletti, Stefano
Zini, Andrea
author_facet Rosafio, Francesca
Bigliardi, Guido
Lelli, Nicoletta
Vandelli, Laura
Naldi, Federica
Ciolli, Ludovico
Meletti, Stefano
Zini, Andrea
author_sort Rosafio, Francesca
collection PubMed
description Background: Platelet function testing is a valid tool to investigate the clinical response to antiplatelet therapy in different clinical settings; in particular, it might supply helpful information in patients with cerebrovascular disease. Oral antiplatelet treatment, such as Aspirin (ASA) and Clopidogrel, is the gold standard in secondary stroke prevention of non-cardiogenic ischemic stroke; conversely, its application as a primary prevention therapy is not routinely recommended in patients with vascular risk factors. Multiple electrode platelet aggregometry (MEA) impedance aggregometer is a validated device to test platelet inhibition induced by ASA or Clopidogrel. Case Report: We report the case of a 78-year-old patient without relevant clinical history, taking ASA as primary prevention strategy, who was admitted for sudden onset of dysarthria and left facial hyposthenia during physical effort. Brain CT revealed two small subcortical bilateral spontaneous intracranial hemorrhages. Platelet aggregometry with MEA performed upon admission revealed a very strong platelet inhibition induced by ASA (result of the ASPI Test was 5 U, consistent with an ultra-responsiveness to ASA, and the cutoff value of correct responsiveness is <40 U). MRI at longitudinal follow-up revealed the presence of two small cavernous angioma underlying hemorrhagic spots. Conclusion: The evaluation of platelet reactivity in stroke patients undergoing antiplatelet therapies, not commonly performed in clinical practice, could be useful to optimize prevention strategies; the verification of the biological effectiveness of ASA or Clopidogrel could be a valid tool in the definition of each patient's risk profile, particularly in patients with cerebrovascular disease known to be at increased risk for both hemorrhagic and thrombotic complications.
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spelling pubmed-83832002021-08-25 Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report Rosafio, Francesca Bigliardi, Guido Lelli, Nicoletta Vandelli, Laura Naldi, Federica Ciolli, Ludovico Meletti, Stefano Zini, Andrea Front Neurol Neurology Background: Platelet function testing is a valid tool to investigate the clinical response to antiplatelet therapy in different clinical settings; in particular, it might supply helpful information in patients with cerebrovascular disease. Oral antiplatelet treatment, such as Aspirin (ASA) and Clopidogrel, is the gold standard in secondary stroke prevention of non-cardiogenic ischemic stroke; conversely, its application as a primary prevention therapy is not routinely recommended in patients with vascular risk factors. Multiple electrode platelet aggregometry (MEA) impedance aggregometer is a validated device to test platelet inhibition induced by ASA or Clopidogrel. Case Report: We report the case of a 78-year-old patient without relevant clinical history, taking ASA as primary prevention strategy, who was admitted for sudden onset of dysarthria and left facial hyposthenia during physical effort. Brain CT revealed two small subcortical bilateral spontaneous intracranial hemorrhages. Platelet aggregometry with MEA performed upon admission revealed a very strong platelet inhibition induced by ASA (result of the ASPI Test was 5 U, consistent with an ultra-responsiveness to ASA, and the cutoff value of correct responsiveness is <40 U). MRI at longitudinal follow-up revealed the presence of two small cavernous angioma underlying hemorrhagic spots. Conclusion: The evaluation of platelet reactivity in stroke patients undergoing antiplatelet therapies, not commonly performed in clinical practice, could be useful to optimize prevention strategies; the verification of the biological effectiveness of ASA or Clopidogrel could be a valid tool in the definition of each patient's risk profile, particularly in patients with cerebrovascular disease known to be at increased risk for both hemorrhagic and thrombotic complications. Frontiers Media S.A. 2021-08-10 /pmc/articles/PMC8383200/ /pubmed/34447344 http://dx.doi.org/10.3389/fneur.2021.663308 Text en Copyright © 2021 Rosafio, Bigliardi, Lelli, Vandelli, Naldi, Ciolli, Meletti and Zini. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Rosafio, Francesca
Bigliardi, Guido
Lelli, Nicoletta
Vandelli, Laura
Naldi, Federica
Ciolli, Ludovico
Meletti, Stefano
Zini, Andrea
Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title_full Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title_fullStr Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title_full_unstemmed Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title_short Why Me? To Be an Ultra-Responder to Antiplatelet Therapy: A Case Report
title_sort why me? to be an ultra-responder to antiplatelet therapy: a case report
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383200/
https://www.ncbi.nlm.nih.gov/pubmed/34447344
http://dx.doi.org/10.3389/fneur.2021.663308
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