Can the Previous Therapeutic Control of the Main Risk Factors of Cerebrovascular Disease Influence the Acetylsalicylic Acid–Nonresponsive Status in Acute Ischemic Stroke Patients? Results from a Portuguese Prospective Cohort Study

• Published in: Journal of stroke and cerebrovascular diseases 2015-06, Vol.24 (6), p.1383-1389
• Main Authors: Freitas-Silva, Margarida, MD, Gonçalves, Luciana, MD, Medeiros, Rui, PhD, Nunes, José Pedro, MD, PhD
• Format: Article
• Language: English
• Subjects: acetylsalicylic acid; Acute ischemic stroke; Aged; Aged, 80 and over; antidiabetic; antihypertensive; Aspirin - therapeutic use; Brain Ischemia - drug therapy; Cardiovascular; cerebrovascular disease; Cerebrovascular Disorders - drug therapy; Cohort Studies; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Middle Aged; Neurology; Platelet Aggregation Inhibitors - therapeutic use; platelet function; Prospective Studies; Stroke - drug therapy; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.02.021

Background Acute ischemic stroke (AIS) is a complex disease, and the therapeutic control of its risk factors may influence the efficacy of acetylsalicylic acid (ASA) and the occurrence of new vascular events. The aim of this study was to investigate the potential in vivo properties of a previous treatment controlling the main risk factors of cerebrovascular disease, in the ASA-nonresponsive status in a Portuguese population. Methods We conducted a prospective cohort study with the recruitment of 90 patients diagnosed with AIS and a follow-up protocol was set up with recurrent stroke as the main clinical end point under evaluation. At admission, PFA-100 (platelet function analyzer) test was evaluated in blood samples from AIS patients treated with 100 mg/day of ASA and previously treated with antihypertensive, antidiabetic, or statin drugs. Results We observed that 30% of patients were ASA nonresponders. Multivariate regression analysis indicated that the previous treatment with antihypertensive drugs emerged with a significant risk reduction of an ASA-nonresponsive status (odds ratio, .119; 95% confidence interval, .026-.538; P  = .006). Furthermore, our results indicated an influence of ASA-nonresponsive status in a decreased period to a new recurrent stroke event in the time frame of 24 months ( P  = .005, log-rank test). Conclusions ASA is an important part of treatment of AIS, and its efficacy may be improved in previous high-risk cerebrovascular patients, particularly with antihypertensive therapeutic control.