Acute hemorrhagic complications are associated with lower coated‐platelet levels in non‐lacunar brain infarction

• Published in: Journal of thrombosis and haemostasis Vol. 13; no. 12; pp. 2233 - 2239
• Main Authors: Prodan, C. I., Stoner, J. A., Dale, G. L.
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01-12-2015
• Subjects: Aged; Blood Coagulation; blood platelets; Blood Platelets - metabolism; brain infarction; Brain Infarction - blood; Brain Infarction - complications; Brain Infarction - diagnosis; Chi-Square Distribution; Female; Hemorrhage; Humans; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - etiology; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Admission; Platelet Activation; Platelet Count; Predictive Value of Tests; Risk Assessment; Risk Factors; Stroke; thrombosis; blood platelets; brain infarction; thrombosis; stroke; hemorrhage
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13160

Summary
Background
Coated platelets are procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated‐platelet levels are elevated in patients with non‐lacunar ischemic stroke and decreased in patients with spontaneous intracerebral hemorrhage as compared with controls.
Objective
To investigate whether acute hemorrhagic complications occurring during the initial hospital admission for non‐lacunar ischemic stroke are associated with lower coated‐platelet levels.
Patients/methods
Coated‐platelet levels were determined in 385 consecutive patients with non‐lacunar stroke. Hemorrhagic complications were defined as either intracranial hemorrhage or significant extracranial bleeding (drop in hemoglobin of ≥ 2 g dL−1). The rate of acute hemorrhagic complication was compared among subjects categorized into tertiles of coated‐platelet levels using an exact Cochrane‐Armitage trend test. Logistic regression was used to estimate the adjusted odds of hemorrhagic complication associated with coated‐platelet levels.
Results
Hemorrhagic complications were present in 15 (3.9%) cases. Of these, four had intracranial hemorrhage and 11 had extracranial hemorrhage. The occurrence of hemorrhagic complications differed among the coated‐platelet tertiles: 10.2% for the first tertile (coated‐platelet levels < 35.5%), 1.5% for the second tertile and 0% for the third tertile (coated‐platelet levels ≥ 47.5%, trend test). Logistic regression showed that the odds of hemorrhagic complication in those with levels < 35.5% were 14.59 times the odds for patients with levels ≥ 35.5% (95% CI: 3.24–65.7).
Conclusions
Lower levels of procoagulant platelets are associated with acute hemorrhagic complications following non‐lacunar ischemic stroke. These results suggest a role for coated‐platelets in risk/benefit assessment in the early stages of stroke.