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- Title
Relationship between 'on-treatment platelet reactivity', shear stress, and micro-embolic signals in asymptomatic and symptomatic carotid stenosis.
- Authors
Murphy, S. J. X.; Lim, S. T.; Kinsella, J. A.; Tierney, S.; Egan, B.; Feeley, T. M.; Murphy, S. M.; Walsh, R. A.; Collins, D. R.; Coughlan, T.; O'Neill, D.; Harbison, J. A.; Madhavan, P.; O'Neill, S. M.; Colgan, M. P.; Cox, D.; Moran, N.; Hamilton, G.; Meaney, J. F.; McCabe, D. J. H.
- Abstract
Background: Assessment of 'high on-treatment platelet reactivity (HTPR)' could enhance understanding of the pathophysiology of first or recurrent vascular events in carotid stenosis patients on antiplatelet therapy. Methods: This prospective, multi-centre study assessed antiplatelet–HTPR status and its relationship with micro-emboli signals (MES) in asymptomatic vs. symptomatic ≥ 50–99% carotid stenosis. Platelet function/reactivity was assessed under 'moderately high shear stress' with the PFA-100® and 'low shear stress' with VerifyNow® and Multiplate® analysers. Bilateral 1-h transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES + ve or MES − ve. Results: Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Median daily aspirin doses were higher in early symptomatic (225 mg; P < 0.001), but not late symptomatic (75 mg; P = 0.62) vs. asymptomatic patients (75 mg). There was a lower prevalence of aspirin–HTPR in early (28.6%; P = 0.028), but not late symptomatic (38.9%; P = 0.22) compared with asymptomatic patients (56.7%) on the PFA-100®, but not on the VerifyNow® or Multiplate® (P ≤ 0.53). Early symptomatic patients had a higher prevalence of aspirin–HTPR on the PFA-100® (28.6%) vs. VerifyNow® (9.5%; P = 0.049), but not Multiplate® assays (11.9%, P = 0.10). There was no difference in aspirin–HTPR prevalence between any symptomatic vs. asymptomatic MES + ve or MES − ve subgroup. Discussion: Recently symptomatic moderate–severe carotid stenosis patients had a lower prevalence of aspirin–HTPR than their asymptomatic counterparts on the PFA-100®, likely related to higher aspirin doses. The prevalence of antiplatelet–HTPR was positively influenced by higher shear stress levels, but not MES status.
- Subjects
SHEARING force; TRANSCRANIAL Doppler ultrasonography; BLOOD platelets; CEREBRAL arteries; RELATIONSHIP status
- Publication
Journal of Neurology, 2020, Vol 267, Issue 1, p168
- ISSN
0340-5354
- Publication type
Article
- DOI
10.1007/s00415-019-09550-3