Adenosine diphosphate-induced platelet aggregation might contribute to poor outcomes in atrial fibrillation-related ischemic stroke

Abstract

Systemic atherosclerosis is involved in ischemic damages and cardioembolism after atrial fibrillation (AF)-related ischemic stroke (IS). Platelet activation is a critical factor in systemic atherosclerosis; however, there is little information regarding the role of platelet activation on the outcome of AF-related IS. We investigated the relationship between adenosine diphosphate (ADP)-induced platelet aggregation and the long-term outcomes of AF-related IS. We studied 249 patients who were exclusively treated with anticoagulation therapy after they had experienced AF-related IS. We evaluated their platelet function 5 days after admission to the hospital by using an optic platelet aggregometer test. We also assessed the prognoses of patients 90 days after the AF-related IS. Our results showed that ADP-induced platelet aggregation was positively correlated with CHA2DS2-VASc scores (r = .285, P < .01). Totally, 107 (43.0%) patients had a poor outcome at 90 days after IS. Univariate analysis showed that the following factors significantly contribute to a poor outcome: older age (odds ratio [OR] = 1.07, confidence interval [CI] 1.04-1.10, P < .01), a history of stroke (OR = 3.24, CI 1.61-6.53, P < .01), high scores on the National Institutes of Health Stroke Scale (NIHSS; OR = 1.25, CI 1.18-1.32, P < .01), increased white blood cell counts (OR = 1.12, CI 1.02-1.24, P < .01), high CHA2DS2-VASc scores (≥5, OR = 7.31, CI 3.36-15.93, P = .025), and the highest tertile of ADP-induced platelet aggregation (≥72%, OR = 3.17, CI 1.67-5.99, P < .01). Of these factors, high NIHSS scores (OR = 1.27, CI 1.20-1.36, P < .01), high CHA2DS2-VASc scores (OR = 4.69, CI 1.21-18.14, P = .03), and the highest tertile of ADP-induced platelet aggregation (OR = 2.49, CI 1.17-5.27, P = .02) were independently associated with a poor outcome at 90 days after IS. Therefore, our results suggest that platelet activation might affect the outcome of AF-related IS.

Keywords: Platelet aggregation; adenosine diphosphate; atrial fibrillation; ischemic stroke.