Prior antiplatelet use and infarct volume in ischemic stroke

• Published in: Journal of the neurological sciences Vol. 264; no. 1; pp. 140 - 144
• Main Authors: Ovbiagele, Bruce, Buck, Brian H, Liebeskind, David S, Starkman, Sidney, Bang, Oh Young, Ali, Latisha K, Villablanca, J. Pablo, Salamon, Noriko, Yun, Susan W, Pineda, Sandra, Saver, Jeffrey L
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier B.V 15.01.2008; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Antiplatelet; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain - blood supply; Brain - drug effects; Brain - pathology; Brain Infarction - drug therapy; Brain Infarction - pathology; Brain Infarction - prevention & control; Brain Ischemia - drug therapy; Brain Ischemia - pathology; Brain Ischemia - physiopathology; Diffusion-weighted imaging; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Intracranial Arteriosclerosis - complications; Intracranial Arteriosclerosis - physiopathology; Ischemic; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - physiopathology; Magnetic Resonance Imaging; Male; Medical sciences; Microcirculation - physiopathology; Middle Aged; Neurology; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Risk Factors; Severity of Illness Index; Stroke; Vascular diseases and vascular malformations of the nervous system; Diffusion-weighted imaging; Stroke; Antiplatelet; Ischemic; Magnetic resonance imaging; Cerebral infarction; Nervous system diseases; Infarct; Diffusion imaging; Cardiovascular disease; Systolic volume; Nuclear magnetic resonance imaging; Cerebral disorder; Stroke volume; Vascular disease; Central nervous system disease; Brain ischemia; Ischemic; Antiplatelet; Diffusion-weighted imaging; Magnetic resonance imaging; Cerebrovascular disease
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2007.08.033

Abstract Background Conflicting data exist on the role of antiplatelet agents in reducing incident ischemic stroke magnitude, but most prior studies used clinically-assessed neurologic deficit as the index of stroke extent rather than more precise volumetric measurements of infarct size. We assessed the relation of premorbid antiplatelet use to initial diffusion-weighted MRI (DWI) lesion volumes among acute ischemic stroke patients. Methods Consecutive patients presenting within 24 h of ischemic stroke over an 18-month period were studied. DWI lesions were outlined using a semi-automated threshold technique. Subjects were categorized into two groups: antiplatelet (AP) or no antithrombotic (NA). The relationship between prestroke antithrombotic status and DWI infarct volumes was examined using multivariate quantile regression. Results One hundred sixty-six individuals met study criteria: 75 AP and 91 NA patients. Median DWI volume was lower in the AP group than in the NA group (1.5 cc vs. 5.4 cc, p = 0.031). A multivariable model (adjusting for age, history of transient ischemic attack, admission temperature, admission blood pressure, admission serum glucose, stroke onset to imaging interval, stroke mechanism, premorbid statin and antihypertensive use) demonstrated smaller infarcts in the AP vs. NA group (adjusted volume difference: − 1.3 cc, 95% CI = − 0.09, − 2.5, p = 0.037). Prior statin use, no history of TIA, large vessel atherosclerosis and microvascular ischemic disease stroke mechanism were also independently associated with reduced infarct volume. Conclusions Prior antiplatelet treatment is independently associated with reduced cerebral infarct volume among acute ischemic stroke patients. Premorbid statin use, TIA history and stroke mechanism also predict infarct volume in ischemic stroke.