Related Experiment Video
Updated: Jul 8, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet Analysis in the Thrombus Plus Serum BNP for Detecting Clot-Related Atrial Fibrillation. Results From the
Jorge Pagola1, Jesus Juega2, Laura Dorado3
1Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Medicine Department, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain. jorge.pagola@vallhebron.cat.
Insights
Identifying occult atrial fibrillation (AF) in stroke patients is crucial. Combining clot platelet (PLT) markers with serum brain natriuretic peptide (BNP) significantly improves detection of AF-associated clots, aiding stroke risk stratification.
Area of Science:
- Neurology
- Cardiology
- Biomarker Research
Background:
- Occult atrial fibrillation (AF) is a significant cause of cryptogenic stroke.
- Accurate identification of AF-associated clots is vital for stroke management and prevention.
- Current diagnostic methods may not fully capture AF-related embolic events.
Purpose of the Study:
- To evaluate the utility of intra-clot markers and serum biomarkers for identifying AF-associated clots.
- To compare clot composition and serum profiles between AF-related and large artery atherosclerosis (LAA) stroke.
- To assess the predictive value of these markers, individually and in combination, for AF clot detection in cryptogenic stroke.
Main Methods:
- Analysis of retrieved thrombi for fibrin, red blood cells, platelets (PLT), and CD4 profiles.
- Measurement of serum biomarkers including D-dimer, lipoprotein (A), and brain natriuretic peptide (BNP).
- Matched case-control study comparing patients with stroke-related AF and LAA stroke, followed by predictive analysis in cryptogenic stroke patients.
Main Results:
- AF-associated clots showed higher PLT percentage (66.64% vs. 55.43%) and lower CD4 percentage (3.84% vs. 7.95%) compared to LAA clots.
- Serum BNP levels were significantly higher in AF clot patients (2114 pg/ml vs. 276 pg/ml).
- Combining PLT percentage with serum BNP demonstrated high predictive ability for AF clot detection (C-test 0.847, p < 0.001).
Conclusions:
- Intra-clot platelet composition and serum BNP levels are associated with AF-related clots.
- The combination of intra-thrombus platelet analysis and serum BNP offers a powerful tool for identifying AF-associated clots.
- This integrated approach can improve the detection of occult AF in patients with cryptogenic stroke, guiding therapeutic strategies.
Abstract:
Occult atrial fibrillation (AF) is a common cause of cryptogenic stroke. This study aimed to investigate the utility of surrogate markers within the clot (clot markers), in combination with serum biomarkers, to identify AF-associated clots in patients who underwent mechanical thrombectomy. Each retrieved thrombus was analyzed to identify fibrin, red blood cells, platelets - CD61 staining (PLT) and T-CD4 lymphocyte/macrophage/monocyte (CD4) profile. Serum biomarkers such as D-dimer, lipoprotein (A), and brain natriuretic peptide (BNP) were also assessed in the acute phase of the stroke. Patients with stroke-related AF and large artery atherosclerosis (LAA) stroke were compared by matched case-control design to identify markers associated with AF clot profile. The predictive abilities of clot markers and serum biomarkers to detect AF clot were tested in patients with cryptogenic stroke. In patients with AF clot, the PLT percentage was higher (66.64% vs. 55.43%, OR = 1.03); CD4 percentage was lower (3.84% vs. 7.95%, OR = 0.95); and BNP marker was higher (2114 pg/ml vs. 276 pg/ml, OR = 1.04) compared to LAA clot. PLT was independently associated to AF-clot (OR, 1.04) but demonstrated moderate ability to identify AF-clot cases (C-test 0.668, p = 0.018). The combination of PLT with BNP significantly improved AF-clot prediction (C-test 0.847, p < 0.001). The clot composition of patients with cryptogenic stroke and AF detection showed four-fold higher PLT and BNP pattern of risk than patients with cryptogenic stroke without AF detection (38.5% vs. 8.7%) (OR = 1.40). Integrating intra-thrombus platelet with serum BNP offers a promising approach for detecting AF-associated clots in patients with cryptogenic stroke.
