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Clin Neurol Neurosurg. 2011 Apr;113(3):196-201. doi: 10.1016/j.clineuro.2010.11.004. Epub 2010 Dec 8.

Aspirin non-responder status and early neurological deterioration: a prospective study.

Author information

1
Department of Neurology, Amiens University Hospital, and Laboratoire de Neurosciences Fonctionnelles et Pathologies, Place V Pauchet, 80000 Amiens, France. bugnicourt.jean-marc@chu-amiens.fr

Abstract

OBJECTIVES:

In acute ischemic stroke, early neurological deterioration (END) has a severe impact on patient outcome. We tested the hypothesis that initial biological aspirin non-responder status (ANRS) helps predict END.

METHODS:

A total of 85 patients with acute ischemic stroke on 160mg aspirin daily were prospectively included. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥4 points in the first 72h after admission. Platelet responsiveness to aspirin was assessed using the PFA-100 system, and ANRS was defined as a collagen/epinephrine closure time <165ms.

RESULTS:

END was observed in 10 patients (11.8%). The presumed reasons for END were progressive stroke (40%), recurrent cerebral ischemia (30%), malignant middle cerebral artery infarction (20%) and secondary acute hydrocephalus (10%). Patients with END had a non-significant worse neurological status on the NIHSS at hospital admission (8.4 vs. 4.2; p=0.15). Initial impaired consciousness (30% vs. 3%), visual disturbance (60% vs. 23%) and ANRS (60% vs. 20%) were observed more frequently in patients with END. In multivariate analysis, impaired consciousness (OR: 17.3; 95% CI: 2.0-149.5; p=0.01) and ANRS (OR: 6.4; 95% CI: 1.4-29.6; p=0.017) were found to be independently associated with END.

CONCLUSION:

ANRS is common in acute ischemic stroke patients and is predictive of END. The clinical significance of these findings requires further evaluation in larger longitudinal studies.

PMID:
21145162
DOI:
10.1016/j.clineuro.2010.11.004
[Indexed for MEDLINE]

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