Platelet activation and aggregation after aneurysmal subarachnoid hemorrhage

Pauline Perez,Anne-Claire Lukaszewicz,Rémy Nizard,Stephanie Lenck,Didier Payen,Ludovic Drouet

doi:10.1186/s12883-018-1062-z

Abstract

BackgroundEndovascular techniques have proven beneficial in the treatment of aneurysmal subarachnoid hemorrhage (aSAH), but with high risk of arterial clotting, emboli and dissection. Platelet activation and alterations in hemostasis may contribute to these complications. We investigated platelet activation and aggregation pathways in aSAH patients who underwent endovascular treatment.MethodsTwo blood samples were taken, in the early days after bleeding and during the period at risk of vasospasm. We studied platelet activation through the expression of GpIIbIIIa and P-selectin as well as aggregation rate in the presence of agonists. Platelets from aSAH patients were compared with those from orthopedic postoperative patients (POSTOP).ResultsPlatelets in aSAH were initially spontaneously activated and remained so over time. aSAH platelets were further activated with rapid aggregation in the presence of agonists, particularly ADP, with behavior comparable to POSTOP platelets.ConclusionsaSAH platelets showed prolonged increases in activation and aggregation. Therapies targeting the ADP pathway might reduce the risk of clotting and ischemic events in this context among patients requiring multiple endovascular procedures.Trial registrationNot applicable.

Highlights

Endovascular techniques have proven beneficial in the treatment of aneurysmal subarachnoid hemorrhage, but with high risk of arterial clotting, emboli and dissection
One of the most disastrous evolutions of Aneurysmal subarachnoid hemorrhage (aSAH) is the occurrence of vasospasm followed often by delayed cerebral ischemia (DCI)
We examined platelet function according to activation pathways in aSAH patients who were likely to require repeated endovascular procedures

Summary

Introduction

Endovascular techniques have proven beneficial in the treatment of aneurysmal subarachnoid hemorrhage (aSAH), but with high risk of arterial clotting, emboli and dissection. Endovascular techniques have proven more beneficial than surgical techniques in treatment of the aneurysm [1] and may help treat vasospasm Such procedures expose patients to high risks of arterial clotting, emboli and dissection [2]. A Cochrane meta-analysis [7] carried out in 2007 showed that patients who were treated with antiplatelet agents had secondary ischemia less often than patients that received no antiplatelet agent, but the results were not statistically significant These patients, based on cohorts mostly undergoing surgical treatment of their aneurysms, have a slightly higher risk of bleeding.

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