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Updated: Dec 25, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year
Adam Wiśniewski1, Karolina Filipska2, Joanna Sikora3
1Department of Neurology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Insights
High on-treatment platelet reactivity (HTPR) significantly increases the risk of recurrent vascular events after stroke. Personalized antiplatelet therapy guided by platelet function is recommended, especially for large-vessel disease.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- High on-treatment platelet reactivity (HTPR) is a concern in patients treated with antiplatelet agents.
- Predicting recurrent vascular events after cerebrovascular incidents is crucial for patient management.
- Understanding the role of platelet reactivity in stroke recurrence, particularly by etiology, is essential.
Purpose of the Study:
- To investigate the predictive role of HTPR in recurrent vascular events following cerebrovascular incidents.
- To assess the association between HTPR and stroke etiology in predicting vascular event recurrence.
- To evaluate the long-term outcomes of patients with non-embolic cerebral ischemia treated with aspirin.
Main Methods:
- A prospective, three-year follow-up study involving 101 patients with non-embolic cerebral ischemia (ischemic stroke or transient ischemic attack).
- Patients received daily aspirin (150 mg). Platelet reactivity was assessed using impedance aggregometry within 24 hours of symptom onset.
- Recurrent vascular events (stroke, TIA, myocardial infarction, systemic embolism, vascular death) were monitored over 36 months.
Main Results:
- Recurrent vascular events occurred in 17.9% of patients with HTPR versus 4.6% with normal platelet reactivity (NTPR).
- Aspirin-resistant individuals had a 4.57-fold higher risk of recurrent vascular events (p=0.0486).
- Large-vessel disease (HR 12.04, p=0.0023) and HTPR (HR 4.28, p=0.0465) were independent predictors of recurrent vascular events.
Conclusions:
- Aspirin resistance in the acute phase of cerebral ischemia is linked to increased medium-term vascular event recurrence.
- The risk is heightened when stroke is attributed to large-vessel disease.
- Personalized antiplatelet treatment guided by platelet function testing may benefit patients at high risk for recurrent strokes, particularly those with large-vessel disease.
Abstract:
Background: The aim of this prospective, a three-year follow-up study, was to establish the role of high on-treatment platelet reactivity (HTPR) in predicting the recurrence of vascular events in patients after cerebrovascular incidents, particularly in the aspect of stroke etiology. Methods: The study included 101 subjects with non-embolic cerebral ischemia (69 patients with ischemic stroke and 32 patients with transient ischemic attack) treated with 150 mg of acetylsalicylic acid (aspirin) a day. The platelet reactivity was tested in the first 24 h after the onset of cerebral ischemia by impedance aggregometry. Recurrent vascular events, including recurrent ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, or sudden death of vascular reason, were assessed 36 months after the onset of cerebral ischemia. Results: Recurrent vascular events occurred between 3 and 9 months after onset in 8.5% of all subjects; in the HTPR subgroup, recurrent vascular events occurred in 17.9%; in the normal on-treatment platelet reactivity (NTPR) subgroup, they occurred in 4.6%. We did not notice early or long-term recurrent events. Aspirin resistant subjects had a significantly higher risk of recurrent vascular events than did aspirin sensitive subjects (Odds ratio (OR) = 4.57, 95% Confidence interval (CI) 1.00-20.64; p = 0.0486). Cox proportional hazard models showed that large-vessel disease (Hazard ratio (HR) 12.04, 95% CI 2.43-59.72; p = 0.0023) and high on-treatment platelet reactivity (HR 4.28, 95% CI 1.02-17.93; p = 0.0465) were independent predictors of recurrent vascular events. Conclusion: Aspirin resistance in the acute phase of cerebral ischemia was associated with a higher risk of recurrent medium-term vascular events, coexisting with large-vessel etiology of stroke. Platelet function-guided personalized antiplatelet treatment should be considered for patients with recurrent strokes, especially when due to large-vessel disease.
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