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Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke

BACKGROUND: Stratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events. OBJECTIVE: The present study aims to dis...

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Autores principales: He, Dan, Guo, Yinping, Zhang, Yi, Zhao, Jing, Wu, Lingshan, Yu, Zhiyuan, Qu, Wensheng, Luo, Xiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209664/
https://www.ncbi.nlm.nih.gov/pubmed/34326196
http://dx.doi.org/10.1136/neurintsurg-2021-017615
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author He, Dan
Guo, Yinping
Zhang, Yi
Zhao, Jing
Wu, Lingshan
Yu, Zhiyuan
Qu, Wensheng
Luo, Xiang
author_facet He, Dan
Guo, Yinping
Zhang, Yi
Zhao, Jing
Wu, Lingshan
Yu, Zhiyuan
Qu, Wensheng
Luo, Xiang
author_sort He, Dan
collection PubMed
description BACKGROUND: Stratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events. OBJECTIVE: The present study aims to discover predictors for hemorrhage events after DAPT based on parameters such as TEG. METHODS: A total of 859 patients with acute ischemic stroke who received DAPT were recruited consecutively. Demographic, clinical, and neuroimaging characteristics were evaluated at baseline; TEG parameters were obtained 7 days later after DAPT. Hemorrhagic events were monitored about 1 month after the stroke. RESULTS: Of the patients, 61 (7.1%) had hemorrhagic events. Patients in the hemorrhage group had a lower adenosine diphosphate (ADP)-induced platelet-fibrin clot maximum amplitude and a higher ADP inhibition rate (ADP%) than those in the non-hemorrhage group (p<0.05). ADP% was confirmed as an independent predictor of hemorrhagic events with an optimal cut-off point of 83.3% (area under the curve (AUC) = 0.665, 95% CI 0.573 to 0.767, p<0.01). We constructed a logistic model based on D-dimer, National Institutes of Health Stroke Scale scores, and ADP% to predict hemorrhagic events in patients with acute ischemic stroke during DAPT (AUC=0.720, 95% CI 0.625 to 0.858, p<0.01), with a sensitivity of 72.1% and a specificity of 76.5%. CONCLUSIONS: Monitoring changes of TEG parameters helps to guide personalized DAPT for patients with ischemic stroke. A 30–82.3% range of ADP% is recommended for DAPT treatment.
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spelling pubmed-92096642022-07-08 Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke He, Dan Guo, Yinping Zhang, Yi Zhao, Jing Wu, Lingshan Yu, Zhiyuan Qu, Wensheng Luo, Xiang J Neurointerv Surg Ischemic Stroke BACKGROUND: Stratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events. OBJECTIVE: The present study aims to discover predictors for hemorrhage events after DAPT based on parameters such as TEG. METHODS: A total of 859 patients with acute ischemic stroke who received DAPT were recruited consecutively. Demographic, clinical, and neuroimaging characteristics were evaluated at baseline; TEG parameters were obtained 7 days later after DAPT. Hemorrhagic events were monitored about 1 month after the stroke. RESULTS: Of the patients, 61 (7.1%) had hemorrhagic events. Patients in the hemorrhage group had a lower adenosine diphosphate (ADP)-induced platelet-fibrin clot maximum amplitude and a higher ADP inhibition rate (ADP%) than those in the non-hemorrhage group (p<0.05). ADP% was confirmed as an independent predictor of hemorrhagic events with an optimal cut-off point of 83.3% (area under the curve (AUC) = 0.665, 95% CI 0.573 to 0.767, p<0.01). We constructed a logistic model based on D-dimer, National Institutes of Health Stroke Scale scores, and ADP% to predict hemorrhagic events in patients with acute ischemic stroke during DAPT (AUC=0.720, 95% CI 0.625 to 0.858, p<0.01), with a sensitivity of 72.1% and a specificity of 76.5%. CONCLUSIONS: Monitoring changes of TEG parameters helps to guide personalized DAPT for patients with ischemic stroke. A 30–82.3% range of ADP% is recommended for DAPT treatment. BMJ Publishing Group 2022-07 2021-07-29 /pmc/articles/PMC9209664/ /pubmed/34326196 http://dx.doi.org/10.1136/neurintsurg-2021-017615 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Ischemic Stroke
He, Dan
Guo, Yinping
Zhang, Yi
Zhao, Jing
Wu, Lingshan
Yu, Zhiyuan
Qu, Wensheng
Luo, Xiang
Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title_full Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title_fullStr Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title_full_unstemmed Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title_short Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
title_sort thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke
topic Ischemic Stroke
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209664/
https://www.ncbi.nlm.nih.gov/pubmed/34326196
http://dx.doi.org/10.1136/neurintsurg-2021-017615
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