Abstract
To explore the correlation of aspirin resistance (AR) with clinical stroke severity and infarct volume using diffusion-weighted imaging (DWI) in 224 Chinese ischemic stroke patients who were taking aspirin before stroke onset. In those patients, the median age was 64 years (IQR, 56-75 years), and males accounting for 54.9%(123)of the total subjects. Fifty of 224 enrolled patients (22.3%; 95% confidence interval (CI), 16.9% to 27.7%) showed AR. In the median regression model, significant increase was estimated in NIHSS score of 0.04 point for every 1-point increase in aspirin reaction units (ARU) (95% CI, 0.02 to 0.06; P<0.001). Diffusion-weighted MRI (DWI)-measured infarct volume were significantly higher in patients with AR as compared with those with AS [13.21 (interquartile ranges [IQR], 8.51-23.88) vs.4.26 (IQR, 1.74-11.62); P<0.001). Furthermore, a statistically significant increase was also measured in NIHSS score of 0.05 point for every 1-point increase in ARU in the median regression model (95% CI, 0.03 to 0.08; P<0.001). The median DWI infarct volume was significantly larger in the highest ARU quartile when compared to that in the low 3 quartiles (P<0.001). In conclusion, stroke patients with AR indicated higher risk of severe strokes and large infarcts compared to patients in the aspirin-sensitive group.
Highlights
Aspirin is the most frequently used anti-platelet agent for primary and secondary prevention of ischemic stroke [1]
In the median regression model, significant increase was estimated in National Institutes of Health Stroke Scale (NIHSS) score of 0.04 point for every 1-point increase in aspirin reaction units (ARU)
A statistically significant increase was measured in NIHSS score of 0.05 point for every 1-point increase in ARU in the median regression model
Summary
Aspirin is the most frequently used anti-platelet agent for primary and secondary prevention of ischemic stroke [1]. Previous evidence by incorporating large samples has documented that aspirin can result in the reduced incidence of both primary and secondary cardio-and cerebrovascular disease by approximately 25% [3]. With the administration of aspirin, an expected level of the inhibition of platelet is still estimated to detect in approximately 30% of stroke patients [9]. Kim et al [10] have documented in their study that with the inclusion of ischemic stroke patients at their acute stage, aspirin associated elevation in platelet reactivity might be related to early neurological deterioration independently over time. Previous evidence have suggested that elevated risk of recurrent stroke [11] and poor clinical outcomes [12] could be found in a number of stroke patients with AR
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