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Licensed Unlicensed Requires Authentication Published by De Gruyter August 8, 2022

Platelet count and clinical outcomes among ischemic stroke patients with endovascular thrombectomy in DIRECT-MT

  • Tian Xu , Yu Zhou , Xinmin Wu , Hongzhi Zhou , Yunfeng Zhang , Chao Yu , Shuang He , Meiyun Lv , Pengfei Yang , Yongwei Zhang , Pengfei Xing , Lei Zhang , Xiaofei Ye , Ya Peng , Sheng Liu , Liyong Zhang , Qiyi Zhu EMAIL logo , Kaifu Ke EMAIL logo , Jianmin Liu and for the DIRECT-MT investigators



The prognostic role of baseline platelet count (PLT) in acute ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy is unclear. Whether PLT modifies alteplase treatment effect on clinical outcome in those patients is also uncertain.


We derived data from a multicenter randomized clinical trial (DIRECT-MT) comparing intravenous alteplase before endovascular treatment vs. endovascular treatment only. The 654 patients with available PLT data were included. Primary outcome was the ordinal modified Rankin Scale (mRS) score evaluated at 90 days. We also assessed various secondary and safety outcomes.


After adjusting for confounding factors, patients in the top tertile of PLT had a significantly lower risk of a worse shift in the distribution of mRS score (Odds Ratio: 0.671, 95% Confidence Interval: 0.473–0.953, p for trend=0.025), major disability and death (Odds Ratio: 0.617, 95% Confidence Interval: 0.393–0.97, p for trend=0.037) as well as death (Odds Ratio: 0.544, 95% Confidence Interval: 0.313–0.947, p for trend=0.031), respectively, compared with the bottom one. Among patients in the bottom tertile of PLT, combination therapy was associated with a better imaging outcome of eTICI score of 2b, 2c or 3 on final angiogram (Odds Ratio: 3.23, 95% Confidence Interval: 1.49–7.002) with a marginally significant interaction effect.


Participants with higher baseline PLT had a decreased risk of poor functional outcomes. Low baseline PLT modified alteplase treatment effect on the eTICI score on final angiogram. Combination therapy was beneficial for patients with low baseline PLT to have a better reperfusion status.

Corresponding authors: Kaifu Ke, MD, PhD, Department of Neurology, Affiliated Hospital of Nantong University, 20 Xisi Road 226001, Nantong, P.R. China, Phone: +86 513 8116 1722, Fax: +86 513 8116 1726, E-mail: ; and Qiyi Zhu, MD, PhD, Department of Neurology, Linyi People’s Hospital of Qingdao University, 276000, Linyi, P.R. China, Phone: 0539 8129100, Fax: 0539 8129100, E-mail:
Tian Xu and Yu Zhou contributed equally to this work.

Funding source: China Postdoctoral Science Foundation funded project

Award Identifier / Grant number: 2020M671564

Funding source: National Natural Science Foundation of China

Award Identifier / Grant number: 81873742

Award Identifier / Grant number: 82073627

Funding source: Jiangsu Provincial Postdoctoral Science Foundation funded project

Award Identifier / Grant number: 2020Z039

Funding source: Jiangsu Elderly Health Research Project

Award Identifier / Grant number: LD2021008

Award Identifier / Grant number: LR2021012

Funding source: Municipal Natural Science Foundation of Nantong

Award Identifier / Grant number: MS22020011

Funding source: Wu Jieping Medical Foundation

Funding source: Stroke Prevention Project of the National Health Commission of the People's Republic of China

Award Identifier / Grant number: GN-2017R0001

  1. Research funding: A grant (GN-2017R0001) from the Stroke Prevention Project of the National Health Commission of the People’s Republic of China; Wu Jieping Medical Foundation; National Natural Science Foundation of China (81873742, 82073627); China Postdoctoral Science Foundation funded project (2020M671564); Jiangsu Provincial Postdoctoral Science Foundation funded project (2020Z039); Jiangsu Elderly Health Research Project (LD2021008, LR2021012); Municipal Natural Science Foundation of Nantong (MS22020011).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The protocol and data collection of the Direct-MT trial was approved by all relevant local Ethics Committees and Research Boards. It was conducted in accordance with the guidelines of the Declaration of Helsinki.


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Received: 2022-03-31
Accepted: 2022-07-11
Published Online: 2022-08-08
Published in Print: 2022-09-27

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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