Abstract
Introduction: Elevated levels of coated-platelets (a subset of procoagulant platelets) are often associated with acute ischemic stroke (AIS). In addition, diabetes mellitus (DM) and chronic inflammation are known risks factor for AIS. Elevated neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) [markers of inflammation] are also reported in AIS. However, prothrombotic and proinflammatory states among DM patients with different AIS subcategories is not known. Hypothesis: To investigate whether coated-platelet levels, NLR and/or PLR among DM and non-DM AIS patients differ. Methods: We studied AIS or transient ischemic attack (TIA) over the period of 1.5 years and AIS (classified as per TOAST criteria). Coated-platelet levels were assayed at admission. Glycated hemoglobin (HbA1c) and leukocyte count with differential were studied. Study population was subcategorized into DM (HbA1c >6.4 and/or DM history) and non-diabetic (HbA1c <6.4). We examined the difference of coated-platelet levels and other continuous variables between groups using Wilcoxon rank test at significance level of 0.05. Results: Our cohort of 60 AIS/TIA patients were 67.0± 7.8 years in age and 23 (38.3%) were current smokers. Thirty-six (60.0%) had DM. Coated-platelet levels of AIS patients with DM [due to large artery atherosclerosis (LAA), cardioembolism (CE) and lacunar etiology] was non-significantly higher than similar cohort without DM [36.8±13.6 vs. 30.9±10.2 (p=0.068)]. Among diabetic AIS patients with LAA, higher levels of coated-platelets was observed compared to rest of the DM patients [42.1±16.0 vs. 31.9±11.3 (p=0.021)]. PLR among AIS patients with DM due to CE etiology was significantly higher as compared to diabetic patients in rest of the cohort [186.3±69.6 vs. 111.7±39.1 (p=0.0002)]. Diabetic AIS patients with LAA had significantly lower PLR as compared to others with DM [98. 5±21.4 vs. 138.8±58.1 (p=0.042)]. Conclusion: Diabetic patients with AIS due to LAA have higher procoagulant platelets and lymphocytosis (decreased PLR), suggestive of chronic inflammation, whereas those with CE etiology have lymphopenia (increased PLR) suggestive of acute inflammation.
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