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Kirkpatrick AC, Vincent AS, Dale GL, Prodan CI. Increased platelet procoagulant potential predicts recurrent stroke and TIA after lacunar infarction. J Thromb Haemost 2020; 18:660-668. [PMID: 31858724 DOI: 10.1111/jth.14714] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mean levels of coated-platelets, a subset of highly procoagulant platelets, are decreased in patients with lacunar as compared to those with non-lacunar stroke. Elevated coated-platelets are associated with increased risk for recurrent infarction in non-lacunar stroke and predict incident stroke after transient ischemic attack (TIA). OBJECTIVE We investigated if coated-platelet levels are predictive of recurrent cerebral ischemia following lacunar stroke. METHODS Coated-platelet levels were assayed in consecutive patients with acute lacunar stroke, who were followed for up to 12 months. Cox proportional hazards regression analysis was used to estimate the combined risk of stroke and TIA at 12 months according to initial coated-platelet levels. RESULTS We enrolled a total of 109 lacunar stroke patients. Eight events were recorded over a mean follow-up period of 10.8 months. A cut-off of 42.6% for coated-platelet levels yielded a sensitivity of 0.75 (0.35-0.97; 95% confidence interval [CI]), specificity of 0.92 (0.85-0.97), positive predictive value of 0.43 (0.26-0.62), and a negative predictive value of 0.98 (0.93-0.99) for recurrent stroke/TIA. The adjusted hazard ratio for recurrent stroke/TIA in patients with coated-platelet levels ≥ 42.6% was 23.9 (95% CI: 4.26-134.4) when compared to those with levels < 42.6%. CONCLUSIONS Identification of increased platelet procoagulant potential may improve our ability to identify patients at higher risk of recurrent stroke/TIA following a lacunar stroke. Further study of mechanisms involved is warranted and may yield novel targets for prevention and treatment.
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Affiliation(s)
- Angelia C Kirkpatrick
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Andrea S Vincent
- Cognitive Science Research Center, University of Oklahoma, Norman, OK, USA
| | - George L Dale
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Jiao Y, Li G, Xing Y, Nie D, Liu X. Influencing factors of hemorrhagic transformation in non-thrombolysis patients with cerebral infarction. Clin Neurol Neurosurg 2019; 181:68-72. [PMID: 31015060 DOI: 10.1016/j.clineuro.2019.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Hemorrhagic transformation (HT) is a serious complication of acute cerebral infarction. The aim of study is to investigate the influencing factors of HT in non-thrombolysis patients with acute cerebral infarction, and to explore its clinical significance. PATIENTS AND METHODS From June 2016 to March 2017, a total of 346 non-thrombolysis patients with acute cerebral infarction hospitalized in the Department of Neurology of Guangdong Second Provincial General Hospital, were chosen and randomly devided into the non-HT group (control) and HT group. A record of 17 indices including the patients'age, gender, hypertension, diabetes, dyslipidemia, hyperhomocystinemia, atrial fibrillation, drinking or smoking, anticoagulation, antithrombosis, international normalized ratio (INR) and platelet count were measured. Then regression analysis was made to find the independent factors for HT. RESULTS It was found that 38 of non-thrombolysis patients with acute cerebral infarction involved in this study were with HT. The indices including dyslipidemia, drinking, atrial fibrillation, antiplatelet aggregation, anticoagulation, INR > 1.7, cholesterin, triglyceride and platelet count showed statistical differences between the HT group and the non-HT group (P < 0.05). According to the binary logistic regression analysis, there was a negative correlation between dyslipidemia and HT (odds ratio (OR)=0.371, 95% confidence interval (CI) 0.186-0.740, P = 0.005), while there was a positive correlation between atrial fibrillation (OR=2.476, 95% CI 1.140-5.377, P=0.022), platelet count (OR=1.006, 95% CI 0.682-1.611, P = 0.007), INR>1.7 (OR=10.889, 95% CI 4.760-24.910, P = 0.000) and HT. CONCLUSION There is independent correlation between dyslipidemia, atrial fibrillation, platelet count, INR > 1.7 and HT. Dyslipidemia is the protective factor for HT, and atrial fibrillation, platelet count, INR > 1.7 are the risk factors for HT.
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Affiliation(s)
- Yonggang Jiao
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, 510000, Guangdong, China
| | - Guocai Li
- Department of Anesthesiology, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, 518034, Guangdong, China
| | - Yilan Xing
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, 510000, Guangdong, China
| | - Da'ao Nie
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, 510000, Guangdong, China
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, 510000, Guangdong, China.
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Nechipurenko DY, Receveur N, Yakimenko AO, Shepelyuk TO, Yakusheva AA, Kerimov RR, Obydennyy SI, Eckly A, Léon C, Gachet C, Grishchuk EL, Ataullakhanov FI, Mangin PH, Panteleev MA. Clot Contraction Drives the Translocation of Procoagulant Platelets to Thrombus Surface. Arterioscler Thromb Vasc Biol 2019; 39:37-47. [DOI: 10.1161/atvbaha.118.311390] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
After activation at the site of vascular injury, platelets differentiate into 2 subpopulations, exhibiting either proaggregatory or procoagulant phenotype. Although the functional role of proaggregatory platelets is well established, the physiological significance of procoagulant platelets, the dynamics of their formation, and spatial distribution in thrombus remain elusive.
Approach and Results—
Using transmission electron microscopy and fluorescence microscopy of arterial thrombi formed in vivo after ferric chloride–induced injury of carotid artery or mechanical injury of abdominal aorta in mice, we demonstrate that procoagulant platelets are located at the periphery of the formed thrombi. Real-time cell tracking during thrombus formation ex vivo revealed that procoagulant platelets originate from different locations within the thrombus and subsequently translocate towards its periphery. Such redistribution of procoagulant platelets was followed by generation of fibrin at thrombus surface. Using in silico model, we show that the outward translocation of procoagulant platelets can be driven by the contraction of the forming thrombi, which mechanically expels these nonaggregating cells to thrombus periphery. In line with the suggested mechanism, procoagulant platelets failed to translocate and remained inside the thrombi formed ex vivo in blood derived from nonmuscle myosin (
MYH9
)-deficient mice. Ring-like distribution of procoagulant platelets and fibrin around the thrombus observed with blood of humans and wild-type mice was not present in thrombi of
MYH9
-knockout mice, confirming a major role of thrombus contraction in this phenomenon.
Conclusions—
Contraction of arterial thrombus is responsible for the mechanical extrusion of procoagulant platelets to its periphery, leading to heterogeneous structure of thrombus exterior.
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Affiliation(s)
- Dmitry Y. Nechipurenko
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Nicolas Receveur
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Alena O. Yakimenko
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Taisiya O. Shepelyuk
- Faculty of Basic Medicine, Lomonosov Moscow State University, Russia (T.O.S.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Alexandra A. Yakusheva
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Roman R. Kerimov
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
| | - Sergei I. Obydennyy
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Anita Eckly
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Catherine Léon
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Christian Gachet
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Ekaterina L. Grishchuk
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.L.G.)
| | - Fazoil I. Ataullakhanov
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia (F.I.A., M.A.P.)
| | - Pierre H. Mangin
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Mikhail A. Panteleev
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia (F.I.A., M.A.P.)
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