Aspirin and statin are recommended for the treatment of acute ischemic stroke. However, whether aspirin and statin pretreatment is associated with clinical outcomes has not been well addressed. This study aimed to evaluate the effect of pre-existing statin and aspirin use on platelet activation and clinical outcome in acute ischemic stroke patients.
We conducted a prospective, multicenter observational study in patients with acute ischemic stroke. Platelet aggregation and platelet–leukocyte aggregates were measured on admission and during 7-10 days after admission. The primary outcome of the study was neurological deterioration (ND) within 10 days after admission. The secondary outcome was a composite of recurrent ischemic stroke, myocardial infarction, and death during the first 3 months after admission. Physical disability was evaluated using the modified Rankin Scale score at 3 months after admission.
Among 1124 enrolled patients, 270 (24%) experienced ND. Higher platelet aggregation and platelet–leukocyte aggregates on admission and during 7-10 days were associated with ND. Platelet aggregation and platelet–leukocyte aggregates on admission were significantly lower in the patients with pre-existing statin or aspirin use than those without treatment. Patients with prestroke concomitant statin and aspirin treatment had significantly lower incidence of ND than those without treatment. Diabetes mellitus, fasting glucose, platelet–leukocyte aggregates, and prestroke concomitant statin and aspirin use were independently associated with ND.
Prestroke concomitant statin and aspirin use is associated with lower neurological deterioration and platelet activity in patients with acute ischemic stroke.
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- Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial.Stroke. 2001; 32: 661-668
- Early neurological deterioration within 24 hours after intravenous rt-PA therapy for stroke patients: the Stroke Acute Management with Urgent Risk Factor Assessment and Improvement rt-PA Registry.Cerebrovasc Dis. 2012; 34: 140-146
- Platelets in atherothrombosis.Nat Med. 2002; 8: 1227-1234
- Inflammation in stroke and focal cerebral ischemia.Surg Neurol. 2006; 66: 232-245
- Course of platelet activation markers after ischemic stroke.Stroke. 2002; 33: 2570-2574
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention.Lancet Neurol. 2009; 8: 453-463
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- Statins: the new aspirin?.Cell Mol Life Sci. 2002; 59: 1771-1786
- Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials.Stroke. 2013; 44: 448-456
- Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality.Am J Cardiol. 2005; 96: 611-616
- Statin treatment and functional outcome after ischemic stroke: case-control and meta-analysis.Stroke. 2011; 42: 1314-1319
- Statins in acute ischemic stroke: a systematic review.J Stroke. 2015; 17: 282-301
- Favorable outcome of ischemic stroke in patients pretreated with statins.Stroke. 2004; 35: 1117-1121
- Effect of pretreatment with statins on the severity of acute ischemic cerebrovascular events.J Neurol Sci. 2004; 221: 5-10
- A new subtype classification of ischemic stroke based on treatment and etiologic mechanism.Eur Neurol. 2007; 57: 96-102
- Antiplatelet drug resistance is associated with early neurological deterioration in acute minor ischemic stroke in the Chinese population.J Neurol. 2016; 263: 1612-1629
- Clopidogrel plus aspirin prevents early neurologic deterioration and improves 6-month outcome in patients with acute large artery atherosclerosis stroke.Clin Appl Thromb Hemost. 2015; 21: 453-461
- Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke?.J Neurol Neurosurg Psychiatry. 2004; 75: 984-987
- Neurofluctuation in patients with subcortical ischemic stroke.Neurology. 2014; 83: 398-405
- Proinflammatory cytokines and early neurological worsening in ischemic stroke.Stroke. 2000; 31: 2325-2329
- A meta-regression analysis of the dose-response effect of aspirin on stroke.Arch Intern Med. 1999; 159: 1248-1253
- Does platelet antiaggregant therapy lessen the severity of stroke?.Neurology. 1985; 35: 632-636
- Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors.Stroke. 2014; 45: 2004-2009
- Clinical deterioration after intravenous recombinant tissue plasminogen activator treatment: a multicenter transcranial Doppler study.Stroke. 2007; 38: 69-74
- Effects of statins on vascular wall: vasomotor function, inflammation, and plaque stability.Cardiovasc Res. 2000; 47: 648-657
- Rosuvastatin reduces platelet activation in heart failure: role of NO bioavailability.Arterioscler Thromb Vasc Biol. 2005; 25: 1071-1077
- Association between enhanced soluble CD40L and prothrombotic state in hypercholesterolemia: effects of statin therapy.Circulation. 2002; 106: 399-402
- Cholesterol level and symptomatic hemorrhagic transformation after ischemic stroke thrombolysis.Neurology. 2007; 68: 737-742
- Von Willebrand factor, soluble P-selectin, and target organ damage in hypertension: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).Hypertension. 2002; 40: 61-66
Published online: October 25, 2016
Accepted: September 22, 2016
Received in revised form: August 21, 2016
Received: July 24, 2016
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.