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.
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
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).
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
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.
1. Berkhemer, OA, Fransen, PS, Beumer, D, van den Berg, LA, Lingsma, HF, Yoo, AJ, et al.. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.10.1056/NEJMoa1411587Search in Google Scholar PubMed
2. Campbell, BC, Mitchell, PJ, Kleinig, TJ, Dewey, HM, Churilov, L, Yassi, N, et al.. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18. https://doi.org/10.1056/nejmoa1414792.Search in Google Scholar PubMed
3. Goyal, M, Demchuk, AM, Menon, BK, Eesa, M, Rempel, JL, Thornton, J, et al.. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30. https://doi.org/10.1056/nejmoa1414905.Search in Google Scholar PubMed
4. Jovin, TG, Chamorro, A, Cobo, E, de Miquel, MA, Molina, CA, Rovira, A, et al.. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306. https://doi.org/10.1056/nejmoa1503780.Search in Google Scholar PubMed
5. Saver, JL, Goyal, M, Bonafe, A, Diener, HC, Levy, EI, Pereira, VM, et al.. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95. https://doi.org/10.1056/nejmoa1415061.Search in Google Scholar PubMed
6. Wu, MD, Atkinson, TM, Lindner, JR. Platelets and von Willebrand factor in atherogenesis. Blood 2017;129:1415–9. https://doi.org/10.1182/blood-2016-07-692673.Search in Google Scholar PubMed PubMed Central
7. Franco, AT, Corken, A, Ware, J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood 2015;126:582–8. https://doi.org/10.1182/blood-2014-08-531582.Search in Google Scholar PubMed PubMed Central
9. Mosimann, PJ, Kaesmacher, J, Gautschi, D, Bellwald, S, Panos, L, Piechowiak, E, et al.. Predictors of unexpected early reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients. Stroke 2018;49:2643–51. https://doi.org/10.1161/strokeaha.118.021685.Search in Google Scholar PubMed
10. Monch, S, Boeckh-Behrens, T, Kreiser, K, Blum, P, Hedderich, D, Maegerlein, C, et al.. Thrombocytopenia and declines in platelet counts: predictors of mortality and outcome after mechanical thrombectomy. J Neurol 2019;266:1588–95. https://doi.org/10.1007/s00415-019-09295-z.Search in Google Scholar PubMed
11. Yang, P, Zhang, Y, Zhang, L, Zhang, Y, Treurniet, KM, Chen, W, et al.. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020;382:1981–93. https://doi.org/10.1056/nejmoa2001123.Search in Google Scholar PubMed
12. Powers, WJ, Derdeyn, CP, Biller, J, Coffey, CS, Hoh, BL, Jauch, EC, et al.. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:3020–35. https://doi.org/10.1161/str.0000000000000074.Search in Google Scholar
13. Brott, T, Adams, HPJr, Olinger, CP, Marler, JR, Barsan, WG, Biller, J, et al.. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–70. https://doi.org/10.1161/01.str.20.7.864.Search in Google Scholar PubMed
14. van Swieten, JC, Koudstaal, PJ, Visser, MC, Schouten, HJ, van Gijn, J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–7. https://doi.org/10.1161/01.str.19.5.604.Search in Google Scholar PubMed
15. Goyal, M, Fargen, KM, Turk, AS, Mocco, J, Liebeskind, DS, Frei, D, et al.. 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerventional Surg 2014;6:83–6. https://doi.org/10.1136/neurintsurg-2013-010665.Search in Google Scholar PubMed PubMed Central
16. von Kummer, R, Broderick, JP, Campbell, BC, Demchuk, A, Goyal, M, Hill, MD, et al.. The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 2015;46:2981–6. https://doi.org/10.1161/strokeaha.115.010049.Search in Google Scholar PubMed
19. Aukrust, P, Halvorsen, B, Ueland, T, Michelsen, AE, Skjelland, M, Gullestad, L, et al.. Activated platelets and atherosclerosis. Expert Rev Cardiovasc Ther 2010;8:1297–307. https://doi.org/10.1586/erc.10.92.Search in Google Scholar PubMed
22. Inanc, Y, Inanc, Y. The effects of neutrophil to lymphocyte and platelet to lymphocyte ratios on prognosis in patients undergoing mechanical thrombectomy for acute ischemic stroke. Ann Ital Chir 2018;89:367–73.Search in Google Scholar
23. Wang, L, Cheng, Q, Peng, M, Lv, D, Zi, W, Xu, G, et al.. The relationship between the platelet to leukocyte ratio and mechanical thrombectomy outcomes in acute ischemic stroke patients. Neurol Res 2020;42:890–6. https://doi.org/10.1080/01616412.2020.1790868.Search in Google Scholar PubMed
24. Kaesmacher, J, Mordasini, P, Arnold, M, Lopez-Cancio, E, Cerda, N, Boeckh-Behrens, T, et al.. Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis. J Neurointerventional Surg 2019;11:20–7. https://doi.org/10.1136/neurintsurg-2018-013834.Search in Google Scholar PubMed PubMed Central
25. Podlasek, A, Dhillon, PS, Butt, W, Grunwald, IQ, England, TJ. Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: a meta-analysis of randomized controlled trials. Int J Stroke 2021;16:621–31. https://doi.org/10.1177/17474930211021353.Search in Google Scholar PubMed
27. Tao, L, Changfu, W, Linyun, L, Bing, M, Xiaohui, H. Correlations of platelet-leukocyte aggregates with P-selectin S290N and P-selectin glycoprotein ligand-1 M62I genetic polymorphisms in patients with acute ischemic stroke. J Neurol Sci 2016;367:95–100. https://doi.org/10.1016/j.jns.2016.05.046.Search in Google Scholar PubMed
28. Duan, H, Cai, Y, Sun, X. Platelet glycoprotein IIb/IIIa polymorphism HPA-3 b/b is associated with increased risk of ischemic stroke in patients under 60 years of age. Med Sci Mon Int Med J Exp Clin Res 2012;18:CR19–24. https://doi.org/10.12659/msm.882195.Search in Google Scholar PubMed PubMed Central
© 2022 Walter de Gruyter GmbH, Berlin/Boston