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

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


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.

MeSH terms

  • Aged
  • Aspirin / therapeutic use*
  • Brain Ischemia / complications
  • Cohort Studies
  • Drug Resistance
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases / drug therapy*
  • Nervous System Diseases / pathology*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Function Tests
  • Prospective Studies
  • Risk Factors
  • Stroke / classification
  • Stroke / drug therapy*
  • Stroke / pathology*


  • Platelet Aggregation Inhibitors
  • Aspirin