Statin and Aspirin Pretreatment Are Associated with Lower Neurological Deterioration and Platelet Activity in Patients with Acute Ischemic Stroke

• Published in: Journal of stroke and cerebrovascular diseases 2017-02, Vol.26 (2), p.352-359
• Main Authors: Yi, Xingyang, MD, Han, Zhao, MD, Wang, Chun, MSc, Zhou, Qiang, MD, Lin, Jing, MD
• Format: Article
• Language: English
• Subjects: Aged; Aspirin - therapeutic use; Brain Ischemia - blood; Brain Ischemia - drug therapy; Brain Ischemia - mortality; Cardiovascular; Disability Evaluation; Drug Therapy, Combination; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; ischemic stroke; Male; Neurological deterioration; Neurology; outcome; platelet activation; Platelet Activation - drug effects; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - therapeutic use; Proportional Hazards Models; Prospective Studies; Stroke - blood; Stroke - drug therapy; Stroke - mortality; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.030

Background Aspirin and statin are recommended for the treatment of acute ischemic stroke. However, whether aspirin and statin pretreatment is associated with clinical outcomes has not been well addressed. This study aimed to evaluate the effect of pre-existing statin and aspirin use on platelet activation and clinical outcome in acute ischemic stroke patients. Methods We conducted a prospective, multicenter observational study in patients with acute ischemic stroke. Platelet aggregation and platelet–leukocyte aggregates were measured on admission and during 7-10 days after admission. The primary outcome of the study was neurological deterioration (ND) within 10 days after admission. The secondary outcome was a composite of recurrent ischemic stroke, myocardial infarction, and death during the first 3 months after admission. Physical disability was evaluated using the modified Rankin Scale score at 3 months after admission. Results Among 1124 enrolled patients, 270 (24%) experienced ND. Higher platelet aggregation and platelet–leukocyte aggregates on admission and during 7-10 days were associated with ND. Platelet aggregation and platelet–leukocyte aggregates on admission were significantly lower in the patients with pre-existing statin or aspirin use than those without treatment. Patients with prestroke concomitant statin and aspirin treatment had significantly lower incidence of ND than those without treatment. Diabetes mellitus, fasting glucose, platelet–leukocyte aggregates, and prestroke concomitant statin and aspirin use were independently associated with ND. Conclusions Prestroke concomitant statin and aspirin use is associated with lower neurological deterioration and platelet activity in patients with acute ischemic stroke.