PMID- 28931362
OWN - NLM
STAT- MEDLINE
DCOM- 20200406
LR  - 20220411
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 35
IP  - 1
DP  - 2020 Jan
TI  - Dual Antiplatelet Therapy Is Associated With Coagulopathy Detectable by 
      Thrombelastography in Acute Stroke.
PG  - 68-73
LID - 10.1177/0885066617729644 [doi]
AB  - BACKGROUND: Thrombelastography (TEG) provides a global, dynamic measure of 
      coagulation. We examined the effect of antiplatelet (AP) medications on 
      coagulation in patients with acute stroke as measured by TEG. METHODS: We 
      reviewed prospectively collected data on patients presenting with acute ischemic 
      stroke (AIS) and spontaneous intracerebral hemorrhage (ICH) between 2009 and 
      2014. Patient demographics and baseline TEG values were compared among 4 
      different drug use groups: aspirin only, clopidogrel only, both aspirin and 
      clopidogrel, and no AP. Multivariable regression models were conducted to compare 
      the differences in TEG components. RESULTS: A total of 202 patients were 
      included, 139 with AIS and 63 with ICH. Forty-eight (24%) patients were taking 
      aspirin alone, 12 (6%) were taking clopidogrel, 16 (8%) dual AP, and 126 (62%) no 
      AP. Dual AP use was associated with prolonged mean R (time to initiate clotting) 
      of 5.5 minutes as compared to no AP use (4.6 minutes, P = .04). Additionally, 
      mean maximal amplitude (MA; final clot strength) and angle (rate of clot 
      formation) were decreased in the dual AP group (MA = 59.3 mm, angle = 57.8 degrees ) as 
      compared to the no AP group (MA = 64.5 mm, angle = 64.5 degrees ; P = .04 and P = .01, 
      respectively). Patients on single AP therapy (either aspirin or clopidogrel) did 
      not differ from those on no AP therapy in any TEG parameters measured. 
      CONCLUSION: Dual AP therapy is associated with a detectable coagulopathy which 
      may have implications in the management of patients with AIS and hemorrhagic 
      stroke. The effects of single AP therapy may not be demonstrated by TEG.
FAU - McDonald, Mark M
AU  - McDonald MM
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
FAU - Almaghrabi, Tareq S
AU  - Almaghrabi TS
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
FAU - Saenz, Daniel M
AU  - Saenz DM
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
FAU - Cai, Chunyan
AU  - Cai C
AD  - Department of Internal Medicine, University of Texas Health Science Center at 
      Houston, Houston, TX, USA.
FAU - Rahbar, Mohammad H
AU  - Rahbar MH
AD  - Department of Internal Medicine, University of Texas Health Science Center at 
      Houston, Houston, TX, USA.
FAU - Choi, H Alex
AU  - Choi HA
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
AD  - Department of Neurology, University of Texas Health Science Center at Houston, 
      TX, USA.
FAU - Lee, Kiwon
AU  - Lee K
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
AD  - Department of Neurology, University of Texas Health Science Center at Houston, 
      TX, USA.
FAU - Grotta, James C
AU  - Grotta JC
AD  - Memorial Hermann Hospital, Houston, TX, USA.
FAU - Chang, Tiffany R
AU  - Chang TR
AD  - Department of Neurosurgery, University of Texas Health Science Center at Houston, 
      Houston, TX, USA.
AD  - Department of Neurology, University of Texas Health Science Center at Houston, 
      TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20170921
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aspirin/*therapeutic use
MH  - Blood Coagulation/physiology
MH  - Clopidogrel/*therapeutic use
MH  - Dual Anti-Platelet Therapy/*methods
MH  - Female
MH  - Hemorrhage/diagnosis/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Prospective Studies
MH  - Stroke/*drug therapy
MH  - Thrombelastography
OTO - NOTNLM
OT  - antiplatelet
OT  - aspirin
OT  - clopidogrel
OT  - coagulation
OT  - stroke
OT  - thrombelastography
EDAT- 2017/09/22 06:00
MHDA- 2020/04/09 06:00
CRDT- 2017/09/22 06:00
PHST- 2017/09/22 06:00 [pubmed]
PHST- 2020/04/09 06:00 [medline]
PHST- 2017/09/22 06:00 [entrez]
AID - 10.1177/0885066617729644 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2020 Jan;35(1):68-73. doi: 10.1177/0885066617729644. Epub 
      2017 Sep 21.