Open AccessCoated-Platelet Trends Predict Short-Term Clinical OutcomeAfter Subarachnoid Hemorrhage
Author(s) -
Bappaditya Ray,
Vijay Pandav,
Eleanor Mathews,
David M. Thompson,
Lance Ford,
Lori K. Yearout,
Bradley N. Bohnstedt,
Shuchi Chaudhary,
George L. Dale,
Călin I. Prodan
Publication year - 2017
Publication title -
translational stroke research
Language(s) - English
Resource type - Journals
eISSN - 1868-601X
pISSN - 1868-4483
DOI - 10.1007/s12975-017-0594-7
Subject(s) - medicine , subarachnoid hemorrhage , neurosurgery , neurology , vascular surgery , term (time) , cardiology , cardiac surgery , surgery , psychiatry , physics , quantum mechanics
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high socio-economic burden. Prothrombotic states of early brain injury (EBI) and delayed cerebral ischemia (DCI) after aSAH determine morbidity and mortality. To understand how activated platelets might contribute to such prothrombotic states, we studied trends in coated-platelets during EBI and DCI periods. Serial blood samples from a prospective cohort of aSAH patients were collected and assayed for coated-platelet levels. Patient's coated-platelet level during post-hospital discharge follow-up served as an estimate of baseline. Occurrence of DCI, Montreal cognitive assessment (MOCA) score of < 26, and modified Rankin scale (mRS) of 3-6 were considered poor clinical outcomes. Non-linear regression analysis detected a transition between periods of rising and declining coated-platelet levels at day 4. Additional regression analyses of coated-platelet trends before day 4 showed differences among patients with modified Fisher 3-4 [4.2% per day (95% CI 2.4, 6.1) vs. - 0.8% per day (95% CI - 3.4, 1.8); p = 0.0023] and those developing DCI [4.6% per day (95% CI 2.8, 6.5) vs. - 1.9% per day (95% CI - 4.5, 0.5); p < 0.001]. Differences between peak coated-platelet levels and baseline levels were larger, on average for those with DCI [18.1 ± 9.6 vs. 10.6 ± 8.0; p = 0.03], MOCA < 26 [17.0 ± 7.8 vs. 10.7 ± 7.4; p = 0.05] and mRS 3-6 [24.8 ± 10.5 vs. 11.9 ± 7.6; p = 0.01]. Coated-platelet trends after aSAH predict DCI and short-term clinical outcomes. The degree of rise in coated-platelets is also associated with adverse clinical outcomes.