AUTHOR=Schrick Diana , Ezer Erzsebet , Tokes-Fuzesi Margit , Szapary Laszlo , Molnar Tihamer 

TITLE=Novel Predictors of Future Vascular Events in Post-stroke Patients—A Pilot Study

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.666994

DOI=10.3389/fneur.2021.666994

ISSN=1664-2295

ABSTRACT=<p><bold>Introduction:</bold> A modified platelet function test (mPFT) was recently found to be superior compared to impedance aggregometry for selection of post-stroke patients with high on-treatment platelet reactivity (HTPR). We aimed to explore some peripheral blood cell characteristics as predictors of recurrent ischemic episodes. The predictive value of mPFT was also assessed in a cohort followed up to 36 months regarding recurrent ischemic vascular events.</p><p><bold>Methods:</bold> As a novelty, not only whole blood (WB), but after 1-h gravity sedimentation the separated upper (UB) and lower half blood (LB) samples were analyzed including neutrophil antisedimentation rate (NAR) in 52 post-stroke patients taking clopidogrel. Area under the curve (AUC, AUC<sub>upper</sub> and AUC<sub>lower</sub>, respectively) was separately measured by Multiplate in the WB, UB and LB samples to characterize <italic>ex vivo</italic> platelet aggregation in the presence of ADP. Next, the occurrence of vascular events (stroke, acute coronary syndrome, ACS) were evaluated during 36-month follow-up.</p><p><bold>Results:</bold> A total of 11 vascular events (stroke <italic>n</italic> = 5, ACS <italic>n</italic> = 6) occurred during the follow-up period. The AUC<sub>upper</sub> was significantly higher in patients with recurrent stroke compared to those with uneventful follow-up (<italic>p</italic> = 0.03). The AUC<sub>upper</sub> with a cut-off value ≥70 based on the mPFT, was able to predict all stroke events (<italic>p</italic> = 0.01), while the total vascular events were independently predicted by NAR with a sensitivity of 82% and specificity of 88%.</p><p><bold>Conclusions:</bold> A combination of NAR reflecting the inflammatory state and AUC<sub>upper</sub> indicating HTPR may provide a better prediction of recurrent ischemic events suggesting a better selection of patients at risk, thus providing an individually tailored vascular therapy.</p>