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High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis

BACKGROUND AND PURPOSE: Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due...

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Autores principales: Noh, Kyung Chul, Choi, Hye-yeon, Woo, Ho Geol, Chang, Jun Young, Heo, Sung Hyuk, Chang, Dae-il, Kim, Bum Joon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurological Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262451/
https://www.ncbi.nlm.nih.gov/pubmed/35796267
http://dx.doi.org/10.3988/jcn.2022.18.4.421
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author Noh, Kyung Chul
Choi, Hye-yeon
Woo, Ho Geol
Chang, Jun Young
Heo, Sung Hyuk
Chang, Dae-il
Kim, Bum Joon
author_facet Noh, Kyung Chul
Choi, Hye-yeon
Woo, Ho Geol
Chang, Jun Young
Heo, Sung Hyuk
Chang, Dae-il
Kim, Bum Joon
author_sort Noh, Kyung Chul
collection PubMed
description BACKGROUND AND PURPOSE: Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. METHODS: Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. RESULTS: Among the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492±83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference=stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. CONCLUSIONS: Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.
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spelling pubmed-92624512022-07-20 High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis Noh, Kyung Chul Choi, Hye-yeon Woo, Ho Geol Chang, Jun Young Heo, Sung Hyuk Chang, Dae-il Kim, Bum Joon J Clin Neurol Original Article BACKGROUND AND PURPOSE: Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. METHODS: Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. RESULTS: Among the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492±83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference=stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. CONCLUSIONS: Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS. Korean Neurological Association 2022-07 2022-03-29 /pmc/articles/PMC9262451/ /pubmed/35796267 http://dx.doi.org/10.3988/jcn.2022.18.4.421 Text en Copyright © 2022 Korean Neurological Association https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Noh, Kyung Chul
Choi, Hye-yeon
Woo, Ho Geol
Chang, Jun Young
Heo, Sung Hyuk
Chang, Dae-il
Kim, Bum Joon
High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title_full High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title_fullStr High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title_full_unstemmed High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title_short High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis
title_sort high-on-aspirin platelet reactivity differs between recurrent ischemic stroke associated with extracranial and intracranial atherosclerosis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262451/
https://www.ncbi.nlm.nih.gov/pubmed/35796267
http://dx.doi.org/10.3988/jcn.2022.18.4.421
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