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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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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. |
format | Online Article Text |
id | pubmed-9209664 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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