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. 2024 Mar 23:17:1127-1138.
doi: 10.2147/IJGM.S450059. eCollection 2024.

Impact of Platelet Hyperreactivity and Diabetes Mellitus on Ischemic Stroke Recurrence: A Single-Center Cohort Clinical Study

Yusheng Mao  1   2 , Bangqiang Zhu  1 , Huiqin Wen  1 , Tao Zhong  1 , Maohong Bian  1
Affiliations

Impact of Platelet Hyperreactivity and Diabetes Mellitus on Ischemic Stroke Recurrence: A Single-Center Cohort Clinical Study

Yusheng Mao et al. Int J Gen Med. .

Abstract

Purpose: Ischemic stroke recurrence (ISR) is prevented by inhibiting platelet function. To investigate the impact of high on-treatment platelet reactivity (HTPR) assessed by thromboelastography (TEG) and its risk factors on ISR in individuals who have experienced acute ischemic stroke (AIS) receiving dual anti-platelet therapy (DAPT).

Patients and methods: At the end of follow-up, a total of 264 patients who met the criteria were enrolled in this cohort study. The primary endpoint event was a recurrence of ischemic stroke within 90 days of onset.

Results: The ISR rate was 7.2% (19/264). The recurrence rate in the HTPR group was 15.1% (8/53), which was significantly higher than the 5.2% (11/211) in the non-HTPR group (p = 0.013), and the type 2 diabetes mellitus (T2DM) group (12.5%, 10/80) was also significantly higher compared to the non-T2DM group (4.9%, 9/184) (p = 0.028). T2DM was an isolated risk factor for HTPR (adjusted OR = 3.06, 95% CI 1.57-5.98, P = 0.001). Kaplan-Meier plots showed that the cumulative risk (CR) of ISR was statistically different in the HTPR and T2DM groups compared to the non-HTPR group (log-rank P = 0.009) and the non-T2DM group (log-rank P = 0.026), respectively. The HTPR and T2DM groups had greater hazard ratios (HR) of ISR than the non-HTPR (adjusted HR = 2.78, 95% CI 1.06-7.32, P = 0.038) and non-T2DM (adjusted HR = 2.64, 95% CI 1.01-6.92, P = 0.049) groups.

Conclusion: Both HTPR and T2DM are linked to ISR. Platelet Inhibition Rate (PIR) of TEG can early identify patients who are at high risk for having another ischemic stroke in patients undergoing DAPT, and this study may offer more evidence in favor of clinically personalized treatment and secondary prevention tactics.

Keywords: clopidogrel; diabetes mellitus; ischemic stroke; platelet activation; thrombelastography.

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Conflict of interest statement

The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Flowchart of patient recruitment.
Figure 2
Figure 2
Comparison of the prevalence of HTPR between T2DM and non-T2DM groups. A Pearson chi-square test was used to determine the difference.
Figure 3
Figure 3
The recurrence rate of an ischemic stroke. (A) The Pearson chi-square test was used to determine the differences in ischemic stroke recurrence rates between patients in the HTPR group and the non-HTPR group; (B) The Pearson chi-square test was used to determine the differences in ischemic stroke recurrence rates between patients in the T2DM group and the non-T2DM group.
Figure 4
Figure 4
Kaplan-Meier curves constructed from HTPR and its risk factors (T2DM). (A) Kaplan-Meier curves depicting the cumulative risk of ischemic stroke recurrence in patients in the HTPR (ADP-induced PIR (%) <30%) group and non-HTPR (ADP-induced PIR (%) ≥30%) group; (B) Kaplan-Meier curves depicting the cumulative risk of ischemic stroke recurrence in patients in the T2DM group and non-T2DM group.
Figure 5
Figure 5
HR forest plot of ischemic stroke recurrence in the HTPR and its risk factors (T2DM) groups. aUnadjusted Cox proportional risk regression model; badjusted Cox proportional risk regression model (age, sex, history of hypertension, history of smoking, current smoking, and multiple cerebral infarcts).
See this image and copyright information in PMC

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