Safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia
10.3724/zdxbyxb-2023-0423
- VernacularTitle:合并血小板减少症的非心源性轻型脑卒中患者早期抗血小板治疗的安全性研究
- Author:
Dongjuan XU
1
;
Huan ZHOU
;
Mengmeng HU
;
Yilei SHEN
;
Hongfei LI
;
Lianyan WEI
;
Jing XU
;
Zhuangzhuang JIANG
;
Xiaoli SHAO
;
Zhenhua XI
;
Songbin HE
;
Min LOU
;
Shaofa KE
Author Information
1. 温州医科大学附属东阳医院神经内科,浙江 金华 322100
- Keywords:
Non-cardioembolic stroke;
Thrombocytopenia;
Antiplatelet therapy;
Safety;
Retrospective study
- From:
Journal of Zhejiang University. Medical sciences
2024;53(2):175-183
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.Methods:Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale(NIHSS)score≤3 and a platelet count<100×109/L were obtained from a multicenter register.Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded.Short-term safety outcomes were in-hospital bleeding events,while the long-term safety outcome was a 1-year all-cause death.The short-term neurological outcomes were evaluated by modified Rankin scale(mRS)score at discharge.Results:A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled.Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge(OR=1.657,95%CI:1.253-2.192,P<0.01)and did not increase the risk of intracranial hemorrhage(OR=2.359,95%CI:0.301-18.503,P>0.05),compared with those without antiplatelet therapy.However,dual-antiplatelet therapy did not bring more neurological benefits(OR=0.923,95%CI:0.690-1.234,P>0.05),but increased the risk of gastrointestinal bleeding(OR= 2.837,95%CI:1.311-6.136,P<0.01)compared with those with mono-antiplatelet therapy.For patients with platelet counts≤75×109/L and>90×109/L,antiplatelet therapy significantly improved neurological functional outcomes(both P<0.05).For those with platelet counts(>75-90)×109/L,antiplatelet therapy resulted in a significant improvement of 1-year survival(P<0.05).For patients even with concurrent coagulation abnormalities,mono-antiplatelet therapy did not increase the risk of various types of bleeding(all P>0.05)but improved neurological functional outcomes(all P<0.01).There was no significant difference in the occurrence of bleeding events,1-year all-cause mortality risk,and neurological functional outcomes between aspirin and clopidogrel(all P>0.05).Conclusions:For non-cardioembolic mild stroke patients with thrombocytopenia,antiplatelet therapy remains a reasonable choice.Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.
