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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Individualized antiplatelet therapy for non-cardiogenic ischemic stroke
Yifan Zhang1, Moli Wang2, Shengyuan Su3
1Department of Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China; Department of Critical Care Medicine, Shenzhen Baoan People's Hospital, Shenzhen, China.
Summary
Individualized antiplatelet therapy using thromboelastography with platelet mapping (TEG-PM) significantly reduced ischemic stroke events. This personalized approach improved patient outcomes without increasing bleeding risks.
Area of Science:
- Neurology
- Cardiology
- Clinical Medicine
Background:
- Antiplatelet therapy is crucial for preventing recurrent ischemic events in non-cardiogenic ischemic stroke.
- Current antiplatelet strategies may not be optimal for all patients, leading to suboptimal treatment or increased bleeding risk.
- Thromboelastography with platelet mapping (TEG-PM) offers a method to assess platelet function and guide personalized therapy.
Purpose of the Study:
- To evaluate the clinical effectiveness of individualized antiplatelet therapy guided by TEG-PM in patients with non-cardiogenic ischemic stroke.
- To compare the incidence of ischemic and bleeding events between patients receiving individualized therapy and those on standard care.
- To identify risk factors influencing the outcomes of personalized antiplatelet treatment.
Main Methods:
- A cohort of 1264 patients with non-cardiogenic ischemic stroke was analyzed, with 684 undergoing TEG-PM testing.
- Patients were divided into an individualized group (n=487) with adjusted antiplatelet therapy based on TEG-PM results (HRPR, LRPR, aspirin/clopidogrel resistance) and a control group (n=197) with standard medication.
- Treatment adjustments included increasing, decreasing, or switching antiplatelet medications.
Main Results:
- The individualized therapy group showed a significantly lower incidence of ischemic events (5.54%) compared to the control group (12.6%, P = 0.001).
- No significant difference in bleeding events was observed between the groups.
- Cox regression identified advanced age (HR, 1.043) and coronary heart disease (HR, 1.902) as significant risk factors for adverse events.
Conclusions:
- Individualized antiplatelet therapy guided by TEG-PM effectively reduces ischemic event risk in non-cardiogenic ischemic stroke patients.
- This personalized approach does not elevate the risk of bleeding or mortality.
- Advanced age and coronary heart disease necessitate careful consideration in managing antiplatelet therapy for stroke patients.
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