Aspirin Resistance in Acute Ischemic Non-cardioembolic Stroke: Frequency and Clinical Study

Yosria Abd -Al Hameed Altaweel¹, Amr Elsayed Kamel¹, Sabah Mohammad Lotfy¹ and Nancy Abd-Al Hameed Mohammad^1,

¹Neurology Department, Zagazig University, Egypt

Cite this paper:
Yosria Abd -Al Hameed Altaweel, Amr Elsayed Kamel, Sabah Mohammad Lotfy and Nancy Abd-Al Hameed Mohammad. Aspirin Resistance in Acute Ischemic Non-cardioembolic Stroke: Frequency and Clinical Study. International Journal of Clinical and Experimental Neurology. 2017; 5(1):33-37. doi: 10.12691/ijcen-5-1-7

Abstract

Platelet activation in cerebrovascular diseases is associated with recurrent stroke and death. Aspirin is an effective antiplatelet agent, exhibiting its action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A₂ (TXA₂). Objectives: The study is designed to find the frequency of aspirin resistance (AR) among acute ischemic non-cardioembolic stroke patients, and to assess the clinical picture of those patients. Mehtods: This study included 80 patients39 males and 41 females (mean age: 63 years ± 11.8 SD), they were diagnosed clinically and via brain imaging within 24 hours following stroke onset. They were given non coated, same preparation of aspirin 150 mg/day regularly and under observation, Low molecular weight heparin 40 mg per day. The patients were followed up clinically and via GCS, NIHSS and APACHEII scales. Assessment of aspirin resistance was done one week after regular aspirin intake through: bleeding time, coagulation time and assessment of thromboxaneA2 level in serum using ELIZA. The patients were classified into two groups aspirin resistant (AR) and aspirin sensitive (AS) and the data were compared in both. Results: AR patients represented 33.75% of our sample. History of TIAs and stroke was more prevalent among them. In AR patients: the followings were also more frequent: more affection of consciousness, power, sensation, language, coordination, vertigo, vomiting, large size of cerebral infarcts, temporal and parietal infarcts. There were high significant negative correlation between GCS and TXA2level and between the later and changes in bleeding time in the first day and 7 days following stroke onset. On the other hand there were high positive correlation between TXA2 level and NIHSS score and infarct size. Coclusion: AR was frequent among ischemic non-cardioembolic stroke and they were associated with history of TIAs and previous strokes, and presented with more severe clinical presentation and larger size of cerebral infarcts, So early identification of AR prevents its fruitless use.

Keywords:
ischemic stroke aspirin resistance platelets

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References:

[1]	Yip HK, Liov CW, Chang HW, Lan MY, Liv JS and Chen MC (2005): Link between platelet activity and outcomes after an ischeamic stroke. Cerebrovasc Dis; 20: 120-128.
[2]	Stewart M, Knoepp and Michael Laposata (2005): Aspirin Resistance: Moving Forward With Multiple Definitions, Different Assays, and a clinical Imperative. Am J Clin Path; 123 (1): 125-13.
[3]	Neki NS (2009): Aspirin resistance current issue. JIACM, 10(3): 134-139.
[4]	Anetta Undas, Kathleen E, Brummel-Ziedins and Kenneth G. Man (2007): Antithrombotic properties of aspirin and resistance to aspirin: beyond strictly antiplatelet actions. Blood; 109: 2285-2292.
[5]	Okay Abaci, Kadriye Orta (2013): Aspirin resistance: where are we now? Anadolu Kardiyol Derg; 13: 370-373.
[6]	Topcuoglo MA, Arsava EM and Hakan AG (2011): Antiplatelet resistance in stroke. Expert Rev Neurother; 11: 251-263.
[7]	IBM Corp. realeased (2013): IBM SPSS Statistics for windows, Version 22.0 Armonk, NY: IBM Corp.
[8]	Lev EI, Solodky A, Harel N, Mager A, Brash D, Assali A, Roller M, Battler A (2010): Treatment of aspirin resistance patients with omega-3 fatty acids versus aspirin dose escalation. J. Am. C. Card.; 55 (2): 114-121.
[9]	Ozben S, Ozben B, Tannikula AM, OZer F, Ozben T (2011): Aspirin resistance in patients with acute ischemic stroke. J Neurol; 258: 1979-1986.
[10]	Laxami SS, Virendra A, Rajesh V, Ashutosh K, Jyotsana S, Isha A (2015): Prevalence of aspirin resistance in patients with ischemic stroke at a tertiary care center in North India. JMSCR, 3 (3): 4684-6493.
[11]	El-Mitwalli A, Azzam H, Abu-Hegazy M, Gomaa M, Wasel Y (2013): Clinical and biochemical aspirin resistance in patients with recurrent cerebral ishcmeia. J. Clin.Neurol. Neurosurg. 115: 9444-94.
[12]	Santos MT, Valles J, Lago A, Tembl J, Sanchez E, Moscardo A, Cosin J (2008): Residual platelet thromboxan A2 and prothrombotic effects of erythrocytes are important determinants of aspirin resistance in patients with vascular disease. J Thromb Hemost; 6: 615-621.
[13]	Zheng AS, Churilov L, Colley RE, Goh C, Davis SM, Yan B (2013): Association of aspirin resistance with increased stroke severity and infarct size. JAMA Neurol; 70 (2): 20-213.
[14]	Knoepp, Stewart M, Laposata M (2005): Aspirin resistance: moving forward with multiple definitions, different assays, and a clinical imperative. Am J Clin Path; 123 (1): 125-132.
[15]	Ahmmad F, Shamsunnahar (2013): Aspirin resistance and newer combatants against it. Farid pur Med Coll J; 8 (2): 92-95.
[16]	Hughes S (2015): Asprin resistance linked to more severe strokes. Medscape Medical News. http://www.medscape.com/reviewarticle/840977
[17]	Oakes K (2015): Larger and more severe strokes seen with aspirin resistance. Glob. Acad. M. Edu.; 19.
[18]	Oh MS, Yu CH, Jung S, Kim C, Jang MU, Lee BC (2016): Aspirin resistance is associated with increased stroke severity and infarct volume. Neurology; 86 (9): 1808-1817.
[19]	Schwammeenthal Y, Tsabri R, Shenkman B, Schwartz R, Matetzky S, Lubetsky A (2008): Aspirin responsiveness in acute brain ischemia: Association with stroke severity and clinical outcome. Cerebrovasc Dis; 25: 355-361.
[20]	Taekim J, Heo S, Lee JS, Choi M, Choi KH, Nam TS, Lee SH, park MS, Kim BC, Kim MK, Cho KH (2015): Aspirin resistance in the acute stages of acute ischemic stroke is associated with the development of new ischemic lesions.
[21]	Frishman WH, Lerner RG, Klein MD, Roganovic M (2003): Antiplatelet and antithrombotic drugs. In: Fr-ishman WH, Sonnenblick EH, Sica DA, eds. Cardiovascular Pharmaceutics. New York, NY: McGraw Hill: 259-299.
[22]	Gum PA, Marchant K, Welch PA, White J, Topol E (2003): A prospective blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular diseases. J Am CollCardiol; 41: 961-965.
[23]	Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS,Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL (2013): An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke American. Stroke; 44 (7): 2064-2089.