Abstract
AimInsulin resistance was reported to increase the risk of ischemic stroke, which can be assessed by the triglyceride glucose (TyG) index. However, it remains unclear whether the TyG index influences the platelet reactivity during the treatment of ischemic patients.MethodsIschemic stroke patients receiving dual antiplatelet therapy (DAPT) within 48 h onset were consecutively included. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The top quartile of TyG index was defined as insulin resistance. The platelet reactivity was assessed by thromboelastography. The platelet inhibition rate induced by arachidonic acid (AA) or adenosine diphosphate (ADP) was used to confirm the high residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel, respectively. The association between TyG index and platelet reactivity was assessed by Kruskal–Wallis test. The independent risk factors of HRPR were determined by multivariate logistic regression analysis.ResultsA total of 1002 patients were included and divided into 4 groups by quartiles of the TyG index (< 2.02; 2.02–2.27; 2.27–2.52; ≥2.52). The findings demonstrated that the maximum intensity of the clot increased, but the AA-induced platelet inhibition rate decreased, depending on the TyG index quartiles. No significant difference was found in the ADP-induced platelet inhibition rate among groups. The prevalence of aspirin HRPR increased depending on the TyG index quartile. Unlike the non-insulin resistance group, the insulin resistance group was independently associated with aspirin HRPR (OR = 1.689, 95% CI 1.14 to 2.51, P = 0.009).ConclusionsIn acute ischemic stroke patients taking DAPT, the elevation of the TyG index is associated with enhanced platelet reactivity and higher prevalence of aspirin HRPR. Insulin resistance assessed by the TyG index could be an independent risk factor for aspirin HRPR.
Highlights
Ischemic stroke is an important health problem worldwide and has the characteristics of high mortality and a high disability rate
Patients were included if: (1) over 18 years old; (2) with a diagnosis of acute ischemic stroke according to clinical symptoms and imaging; (3) receiving dual antiplatelet therapy (DAPT) within 48 h of symptom onset, according to guidelines when diagnosed as acute minor ischemic stroke (with a National Institutes of Health Stroke Scale (NIHSS) score ≤ 3) [24], high-risk transient ischemic attack (TIA, with a ABCD2 score ≥ 4), or symptomatic severe stenosis (70–99%) of a major intracranial artery [2, 25], without evidences of cardioembolism
A higher triglyceride glucose (TyG) index was related to a higher percentage of males, a history of diabetes mellitus, non-smoking cohorts, as well as the elevation of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), LDL-C, creatinine, platelet count, fasting glucose, and HbA1c (P < 0.05)
Summary
Ischemic stroke is an important health problem worldwide and has the characteristics of high mortality and a high disability rate. Reducing the incidence of stroke and improving the prognosis of stroke are problems that. Guo et al BMC Neurol (2021) 21:409 a reduced platelet inhibition rate and the absence of an antiplatelet effect [7]. More and more evidence shows that insulin resistance is common in ischemic stroke patients [13, 14]. Insulin resistance is independently related to the adverse clinical consequences of ischemic stroke, which can exacerbate the neurologic worsening during hospitalization and trigger the recurrence of ischemic stroke [15, 16]. The correlation between insulin resistance and platelet reactivity in acute ischemic stroke patients treated with dual antiplatelet therapy (DAPT) is unknown
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