Association Between Mean Platelet Volume and Hemorrhagic Transformation in Acute Ischemic Stroke Patients

Author(s): Changyi Wang, Lu Wang, Linghui Deng, Shi Qiu, Shihong Zhang, Ming Liu, Bo Wu*

Journal Name: Current Neurovascular Research

Volume 17 , Issue 1 , 2020

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Abstract:

Background: Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Mean platelet volume (MPV) is a marker of platelet function. The relationship between MPV and HT remains unclear.

Methods: From January 1st, 2012 to December 31st 2016, we consecutively enrolled AIS patients admitted to the Department of Neurology of West China Hospital. MPV was measured on admission. HT was diagnosed by brain imaging and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Moreover, subjects were divided into tertiles according to MPV levels. Confounders were identified by univariate analysis and multivariate logistic regression was performed to explore the association between MPV and HT as well as HT subtypes. Also, a generalized additive model was used to investigate whether a non-linear association existed between MPV and HT.

Results: A total of 783 AIS patients were included. 63 patients (8.0%) developed HT: 34 (4.3%) HI and 29 (3.7%) PH. It was observed that MPV positively correlated with HT. After adjustment for confounders, patients in the highest MPV tertile had a significantly increased risk of HT compared to patients in the lowest tertile (odds ratio 2.3, 95% confidence interval 1.0-5.4, P=0.04). The risk of HT increased step-wise across MPV tertiles (P for trend=0.04). MPV tertiles significantly correlated with HI rather than PH. The generalized additive model demonstrated a nonlinear association between MPV and HT (P=0.02).

Conclusion: The risk of HT increased with increasing MPV level in a dose-dependent manner. Patients with elevated MPV levels were more likely to develop HI rather than PH.

Keywords: Mean platelet volume, hemorrhagic transformation, acute ischemic stroke, association, hemorrhagic infarct, parenchymal hematoma.

[1]
Álvarez-Sabín, J.; Maisterra, O.; Santamarina, E.; Kase, C.S. Factors influencing haemorrhagic transformation in ischaemic stroke. Lancet Neurol., 2013, 12(7), 689-705.
[http://dx.doi.org/10.1016/S1474-4422(13)70055-3] [PMID: 23726850]
[2]
Ribatti, D.; Crivellato, E. Giulio Bizzozero and the discovery of platelets. Leuk. Res., 2007, 31(10), 1339-1341.
[http://dx.doi.org/10.1016/j.leukres.2007.02.008] [PMID: 17383722]
[3]
Davì, G.; Patrono, C. Platelet activation and atherothrombosis. N. Engl. J. Med., 2007, 357(24), 2482-2494.
[http://dx.doi.org/10.1056/NEJMra071014] [PMID: 18077812]
[4]
Kamath, S.; Blann, A.D.; Lip, G.Y. Platelet activation: Assessment and quantification. Eur. Heart J., 2001, 22(17), 1561-1571.
[http://dx.doi.org/10.1053/euhj.2000.2515] [PMID: 11492985]
[5]
Bath, P.M.; Butterworth, R.J. Platelet size: Measurement, physiology and vascular disease. Blood Coagul. Fibrinolysis, 1996, 7(2), 157-161.
[http://dx.doi.org/10.1097/00001721-199603000-00011] [PMID: 8735807]
[6]
Sadeghi, F.; Kovács, S.; Zsóri, K.S.; Csiki, Z.; Bereczky, Z.; Shemirani, A.H. Platelet count and mean volume in acute stroke: A systematic review and meta-analysis. Platelets, 2019, 26, 1-9.
[http://dx.doi.org/10.1080/09537104.2019.1680826] [PMID: 31657263]
[7]
Greisenegger, S.; Endler, G.; Hsieh, K.; Tentschert, S.; Mannhalter, C.; Lalouschek, W. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke, 2004, 35(7), 1688-1691.
[http://dx.doi.org/10.1161/01.STR.0000130512.81212.a2] [PMID: 15143290]
[8]
Dai, Z.; Gao, J.; Li, S. Mean platelet volume as a predictor for restenosis after carotid angioplasty and stenting. Stroke, 2018, 49(4), 872-876.
[http://dx.doi.org/10.1161/STROKEAHA.117.019748] [PMID: 29559579]
[9]
Peng, F.; Zheng, W.; Li, F. Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy. J. Neurointerv. Surg., 2018, 10(1), 25-28.
[http://dx.doi.org/10.1136/neurintsurg-2016-012849] [PMID: 28082446]
[10]
Wu, B.; Lin, S.; Hao, Z. Proportion, risk factors and outcome of lacunar infarction: A hospital-based study in a Chinese population. Cerebrovasc. Dis., 2010, 29(2), 181-187.
[http://dx.doi.org/10.1159/000267277] [PMID: 20029187]
[11]
Adams, H.P., Jr; Bendixen, B.H.; Kappelle, L.J. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24(1), 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[12]
Hacke, W.; Kaste, M.; Fieschi, C. Second European-Australasian acute stroke study investigators. randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet, 1998, 352(9136), 1245-1251.
[http://dx.doi.org/10.1016/S0140-6736(98)08020-9] [PMID: 9788453]
[13]
Park, S.Y.; Freedman, N.D.; Haiman, C.A.; Le Marchand, L.; Wilkens, L.R.; Setiawan, V.W. Association of coffee consumption with total and cause-specific mortality among nonwhite populations. Ann. Intern. Med., 2017, 167(4), 228-235.
[http://dx.doi.org/10.7326/M16-2472] [PMID: 28693036]
[14]
Ruggeri, Z.M. Platelets in atherothrombosis. Nat. Med., 2002, 8(11), 1227-1234.
[http://dx.doi.org/10.1038/nm1102-1227] [PMID: 12411949]
[15]
Bath, P.; Algert, C.; Chapman, N.; Neal, B. PROGRESS Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke, 2004, 35(3), 622-626.
[http://dx.doi.org/10.1161/01.STR.0000116105.26237.EC] [PMID: 14976328]
[16]
Staszewski, J.; Pogoda, A.; Data, K. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin. Interv. Aging, 2019, 14, 493-503.
[http://dx.doi.org/10.2147/CIA.S195451] [PMID: 30880930]
[17]
Xie, D.; Xiang, W.; Weng, Y. Platelet volume indices for the prognosis of acute ischemic stroke patients with intravenous thrombolysis. Int. J. Neurosci., 2019, 129(4), 344-349.
[http://dx.doi.org/10.1080/00207454.2018.1536054] [PMID: 30311813]
[18]
De Meyer, S.F.; Denorme, F.; Langhauser, F.; Geuss, E.; Fluri, F.; Kleinschnitz, C. Thromboinflammation in stroke brain damage. Stroke, 2016, 47(4), 1165-1172.
[http://dx.doi.org/10.1161/STROKEAHA.115.011238] [PMID: 26786115]
[19]
Gasparyan, A.Y.; Ayvazyan, L.; Mikhailidis, D.P.; Kitas, G.D. Mean platelet volume: A link between thrombosis and inflammation? Curr. Pharm. Des., 2011, 17(1), 47-58.
[http://dx.doi.org/10.2174/138161211795049804] [PMID: 21247392]
[20]
Li, J.; Kim, K.; Barazia, A.; Tseng, A.; Cho, J. Platelet-neutrophil interactions under thromboinflammatory conditions. Cell. Mol. Life Sci., 2015, 72(14), 2627-2643.
[http://dx.doi.org/10.1007/s00018-015-1845-y] [PMID: 25650236]
[21]
Martin, J.F.; Trowbridge, E.A.; Salmon, G.; Plumb, J. The biological significance of platelet volume: Its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb. Res., 1983, 32(5), 443-460.
[http://dx.doi.org/10.1016/0049-3848(83)90255-4] [PMID: 6658722]
[22]
O’Malley, T.; Langhorne, P.; Elton, R.A.; Stewart, C. Platelet size in stroke patients. Stroke, 1995, 26(6), 995-999.
[http://dx.doi.org/10.1161/01.STR.26.6.995] [PMID: 7762052]
[23]
Smith, N.M.; Pathansali, R.; Bath, P.M. Platelets and stroke. Vasc. Med., 1999, 4(3), 165-172.
[http://dx.doi.org/10.1177/1358836X9900400307] [PMID: 10512596]
[24]
Smith, N.M.; Pathansali, R.; Bath, P.M. Altered megakaryocyte-platelet-haemostatic axis in patients with acute stroke. Platelets, 2002, 13(2), 113-120.
[http://dx.doi.org/10.1080/09537100120111559] [PMID: 11897047]
[25]
Butterworth, R.J.; Bath, P.M. The relationship between mean platelet volume, stroke subtype and clinical outcome. Platelets, 1998, 9(6), 359-364.
[http://dx.doi.org/10.1080/09537109876429] [PMID: 16793719]
[26]
Arnould, M.C.; Grandin, C.B.; Peeters, A.; Cosnard, G.; Duprez, T.P. Comparison of CT and three MR sequences for detecting and categorizing early (48 hours) hemorrhagic transformation in hyperacute ischemic stroke. AJNR Am. J. Neuroradiol., 2004, 25(6), 939-944.www.ncbi.nlm.nih.gov/pubmed/31657263
[PMID: 15205127]


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VOLUME: 17
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DOI: 10.2174/1567202617666191226115518
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