Cargando…
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...
Autores principales: | , , , , , , , |
---|---|
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 |
_version_ | 1783741689104433152 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8383200 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT rosafiofrancesca whymetobeanultrarespondertoantiplatelettherapyacasereport AT bigliardiguido whymetobeanultrarespondertoantiplatelettherapyacasereport AT lellinicoletta whymetobeanultrarespondertoantiplatelettherapyacasereport AT vandellilaura whymetobeanultrarespondertoantiplatelettherapyacasereport AT naldifederica whymetobeanultrarespondertoantiplatelettherapyacasereport AT ciolliludovico whymetobeanultrarespondertoantiplatelettherapyacasereport AT melettistefano whymetobeanultrarespondertoantiplatelettherapyacasereport AT ziniandrea whymetobeanultrarespondertoantiplatelettherapyacasereport |