Author:
He Dan,Guo Yinping,Zhang Yi,Zhao Jing,Wu Lingshan,Yu Zhiyuan,Qu Wensheng,Luo Xiang
Abstract
BackgroundStratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events.ObjectiveThe present study aims to discover predictors for hemorrhage events after DAPT based on parameters such as TEG.MethodsA total of 859 patients with acute ischemic stroke who received DAPT were recruited consecutively. Demographic, clinical, and neuroimaging characteristics were evaluated at baseline; TEG parameters were obtained 7 days later after DAPT. Hemorrhagic events were monitored about 1 month after the stroke.ResultsOf the patients, 61 (7.1%) had hemorrhagic events. Patients in the hemorrhage group had a lower adenosine diphosphate (ADP)-induced platelet-fibrin clot maximum amplitude and a higher ADP inhibition rate (ADP%) than those in the non-hemorrhage group (p<0.05). ADP% was confirmed as an independent predictor of hemorrhagic events with an optimal cut-off point of 83.3% (area under the curve (AUC) = 0.665, 95% CI 0.573 to 0.767, p<0.01). We constructed a logistic model based on D-dimer, National Institutes of Health Stroke Scale scores, and ADP% to predict hemorrhagic events in patients with acute ischemic stroke during DAPT (AUC=0.720, 95% CI 0.625 to 0.858, p<0.01), with a sensitivity of 72.1% and a specificity of 76.5%.ConclusionsMonitoring changes of TEG parameters helps to guide personalized DAPT for patients with ischemic stroke. A 30–82.3% range of ADP% is recommended for DAPT treatment.
Funder
The Natural Science Foundation of Guangdong Province
The Flagship Program of Tongji Hospital
The Application Foundation Frontier Special Project of Wuhan Science and Technology Bureau
Key Research and Development Program of Hubei Province
The National Nature Science Foundation of China
The Science and Technology Program of Guangzhou
Subject
Neurology (clinical),General Medicine,Surgery
Cited by
9 articles.
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