Home Platelet count and clinical outcomes among ischemic stroke patients with endovascular thrombectomy in DIRECT-MT
Article
Licensed
Unlicensed Requires Authentication

Platelet count and clinical outcomes among ischemic stroke patients with endovascular thrombectomy in DIRECT-MT

  • Tian Xu , Yu Zhou , Xinmin Wu , Hongzhi Zhou , Yunfeng Zhang , Chao Yu , Shuang He , Meiyun Lv , Pengfei Yang , Yongwei Zhang , Pengfei Xing , Lei Zhang , Xiaofei Ye , Ya Peng , Sheng Liu , Liyong Zhang , Qiyi Zhu EMAIL logo , Kaifu Ke EMAIL logo , Jianmin Liu and for the DIRECT-MT investigators
Published/Copyright: August 8, 2022
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 60 Issue 10

Abstract

Objectives

The prognostic role of baseline platelet count (PLT) in acute ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy is unclear. Whether PLT modifies alteplase treatment effect on clinical outcome in those patients is also uncertain.

Methods

We derived data from a multicenter randomized clinical trial (DIRECT-MT) comparing intravenous alteplase before endovascular treatment vs. endovascular treatment only. The 654 patients with available PLT data were included. Primary outcome was the ordinal modified Rankin Scale (mRS) score evaluated at 90 days. We also assessed various secondary and safety outcomes.

Results

After adjusting for confounding factors, patients in the top tertile of PLT had a significantly lower risk of a worse shift in the distribution of mRS score (Odds Ratio: 0.671, 95% Confidence Interval: 0.473–0.953, p for trend=0.025), major disability and death (Odds Ratio: 0.617, 95% Confidence Interval: 0.393–0.97, p for trend=0.037) as well as death (Odds Ratio: 0.544, 95% Confidence Interval: 0.313–0.947, p for trend=0.031), respectively, compared with the bottom one. Among patients in the bottom tertile of PLT, combination therapy was associated with a better imaging outcome of eTICI score of 2b, 2c or 3 on final angiogram (Odds Ratio: 3.23, 95% Confidence Interval: 1.49–7.002) with a marginally significant interaction effect.

Conclusions

Participants with higher baseline PLT had a decreased risk of poor functional outcomes. Low baseline PLT modified alteplase treatment effect on the eTICI score on final angiogram. Combination therapy was beneficial for patients with low baseline PLT to have a better reperfusion status.

Keywords: acute ischemic stroke; alteplase; endovascular thrombectomy; platelet count; prognosis
Corresponding authors: Kaifu Ke, MD, PhD, Department of Neurology, Affiliated Hospital of Nantong University, 20 Xisi Road 226001, Nantong, P.R. China, Phone: +86 513 8116 1722, Fax: +86 513 8116 1726, E-mail: ; and Qiyi Zhu, MD, PhD, Department of Neurology, Linyi People’s Hospital of Qingdao University, 276000, Linyi, P.R. China, Phone: 0539 8129100, Fax: 0539 8129100, E-mail:
Tian Xu and Yu Zhou contributed equally to this work.

Funding source: China Postdoctoral Science Foundation funded project

Award Identifier / Grant number: 2020M671564

Funding source: National Natural Science Foundation of China

Award Identifier / Grant number: 81873742

Award Identifier / Grant number: 82073627

Funding source: Jiangsu Provincial Postdoctoral Science Foundation funded project

Award Identifier / Grant number: 2020Z039

Funding source: Jiangsu Elderly Health Research Project

Award Identifier / Grant number: LD2021008

Award Identifier / Grant number: LR2021012

Funding source: Municipal Natural Science Foundation of Nantong

Award Identifier / Grant number: MS22020011

Funding source: Wu Jieping Medical Foundation

Funding source: Stroke Prevention Project of the National Health Commission of the People's Republic of China

Award Identifier / Grant number: GN-2017R0001

  1. Research funding: A grant (GN-2017R0001) from the Stroke Prevention Project of the National Health Commission of the People’s Republic of China; Wu Jieping Medical Foundation; National Natural Science Foundation of China (81873742, 82073627); China Postdoctoral Science Foundation funded project (2020M671564); Jiangsu Provincial Postdoctoral Science Foundation funded project (2020Z039); Jiangsu Elderly Health Research Project (LD2021008, LR2021012); Municipal Natural Science Foundation of Nantong (MS22020011).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The protocol and data collection of the Direct-MT trial was approved by all relevant local Ethics Committees and Research Boards. It was conducted in accordance with the guidelines of the Declaration of Helsinki.

References

1. Berkhemer, OA, Fransen, PS, Beumer, D, van den Berg, LA, Lingsma, HF, Yoo, AJ, et al.. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.10.1056/NEJMoa1411587Search in Google Scholar PubMed

2. Campbell, BC, Mitchell, PJ, Kleinig, TJ, Dewey, HM, Churilov, L, Yassi, N, et al.. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18. https://doi.org/10.1056/nejmoa1414792.Search in Google Scholar PubMed

3. Goyal, M, Demchuk, AM, Menon, BK, Eesa, M, Rempel, JL, Thornton, J, et al.. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30. https://doi.org/10.1056/nejmoa1414905.Search in Google Scholar PubMed

4. Jovin, TG, Chamorro, A, Cobo, E, de Miquel, MA, Molina, CA, Rovira, A, et al.. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306. https://doi.org/10.1056/nejmoa1503780.Search in Google Scholar PubMed

5. Saver, JL, Goyal, M, Bonafe, A, Diener, HC, Levy, EI, Pereira, VM, et al.. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95. https://doi.org/10.1056/nejmoa1415061.Search in Google Scholar PubMed

6. Wu, MD, Atkinson, TM, Lindner, JR. Platelets and von Willebrand factor in atherogenesis. Blood 2017;129:1415–9. https://doi.org/10.1182/blood-2016-07-692673.Search in Google Scholar PubMed PubMed Central

7. Franco, AT, Corken, A, Ware, J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood 2015;126:582–8. https://doi.org/10.1182/blood-2014-08-531582.Search in Google Scholar PubMed PubMed Central

8. Rubenstein, DA, Yin, W. Platelet-activation mechanisms and vascular remodeling. Compr Physiol 2018;8:1117–56.10.1002/cphy.c170049Search in Google Scholar PubMed

9. Mosimann, PJ, Kaesmacher, J, Gautschi, D, Bellwald, S, Panos, L, Piechowiak, E, et al.. Predictors of unexpected early reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients. Stroke 2018;49:2643–51. https://doi.org/10.1161/strokeaha.118.021685.Search in Google Scholar PubMed

10. Monch, S, Boeckh-Behrens, T, Kreiser, K, Blum, P, Hedderich, D, Maegerlein, C, et al.. Thrombocytopenia and declines in platelet counts: predictors of mortality and outcome after mechanical thrombectomy. J Neurol 2019;266:1588–95. https://doi.org/10.1007/s00415-019-09295-z.Search in Google Scholar PubMed

11. Yang, P, Zhang, Y, Zhang, L, Zhang, Y, Treurniet, KM, Chen, W, et al.. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020;382:1981–93. https://doi.org/10.1056/nejmoa2001123.Search in Google Scholar PubMed

12. Powers, WJ, Derdeyn, CP, Biller, J, Coffey, CS, Hoh, BL, Jauch, EC, et al.. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:3020–35. https://doi.org/10.1161/str.0000000000000074.Search in Google Scholar

13. Brott, T, Adams, HPJr, Olinger, CP, Marler, JR, Barsan, WG, Biller, J, et al.. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–70. https://doi.org/10.1161/01.str.20.7.864.Search in Google Scholar PubMed

14. van Swieten, JC, Koudstaal, PJ, Visser, MC, Schouten, HJ, van Gijn, J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–7. https://doi.org/10.1161/01.str.19.5.604.Search in Google Scholar PubMed

15. Goyal, M, Fargen, KM, Turk, AS, Mocco, J, Liebeskind, DS, Frei, D, et al.. 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerventional Surg 2014;6:83–6. https://doi.org/10.1136/neurintsurg-2013-010665.Search in Google Scholar PubMed PubMed Central

16. von Kummer, R, Broderick, JP, Campbell, BC, Demchuk, A, Goyal, M, Hill, MD, et al.. The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 2015;46:2981–6. https://doi.org/10.1161/strokeaha.115.010049.Search in Google Scholar PubMed

17. Durrleman, S, Simon, R. Flexible regression models with cubic splines. Stat Med 1989;8:551–61. https://doi.org/10.1002/sim.4780080504.Search in Google Scholar PubMed

18. Lievens, D, von Hundelshausen, P. Platelets in atherosclerosis. Thromb Haemostasis 2011;106:827–38. https://doi.org/10.1160/th11-08-0592.Search in Google Scholar PubMed

19. Aukrust, P, Halvorsen, B, Ueland, T, Michelsen, AE, Skjelland, M, Gullestad, L, et al.. Activated platelets and atherosclerosis. Expert Rev Cardiovasc Ther 2010;8:1297–307. https://doi.org/10.1586/erc.10.92.Search in Google Scholar PubMed

20. Boilard, E, Duchez, AC, Brisson, A. The diversity of platelet microparticles. Curr Opin Hematol 2015;22:437–44. https://doi.org/10.1097/moh.0000000000000166.Search in Google Scholar

21. Flaumenhaft, R. Formation and fate of platelet microparticles. Blood Cells Mol Dis 2006;36:182–7. https://doi.org/10.1016/j.bcmd.2005.12.019.Search in Google Scholar PubMed

22. Inanc, Y, Inanc, Y. The effects of neutrophil to lymphocyte and platelet to lymphocyte ratios on prognosis in patients undergoing mechanical thrombectomy for acute ischemic stroke. Ann Ital Chir 2018;89:367–73.Search in Google Scholar

23. Wang, L, Cheng, Q, Peng, M, Lv, D, Zi, W, Xu, G, et al.. The relationship between the platelet to leukocyte ratio and mechanical thrombectomy outcomes in acute ischemic stroke patients. Neurol Res 2020;42:890–6. https://doi.org/10.1080/01616412.2020.1790868.Search in Google Scholar PubMed

24. Kaesmacher, J, Mordasini, P, Arnold, M, Lopez-Cancio, E, Cerda, N, Boeckh-Behrens, T, et al.. Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis. J Neurointerventional Surg 2019;11:20–7. https://doi.org/10.1136/neurintsurg-2018-013834.Search in Google Scholar PubMed PubMed Central

25. Podlasek, A, Dhillon, PS, Butt, W, Grunwald, IQ, England, TJ. Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: a meta-analysis of randomized controlled trials. Int J Stroke 2021;16:621–31. https://doi.org/10.1177/17474930211021353.Search in Google Scholar PubMed

26. Srinivas, TR, Ho, B, Kang, J, Kaplan, B. Post hoc analyses: after the facts. Transplantation 2015;99:17–20. https://doi.org/10.1097/tp.0000000000000581.Search in Google Scholar PubMed

27. Tao, L, Changfu, W, Linyun, L, Bing, M, Xiaohui, H. Correlations of platelet-leukocyte aggregates with P-selectin S290N and P-selectin glycoprotein ligand-1 M62I genetic polymorphisms in patients with acute ischemic stroke. J Neurol Sci 2016;367:95–100. https://doi.org/10.1016/j.jns.2016.05.046.Search in Google Scholar PubMed

28. Duan, H, Cai, Y, Sun, X. Platelet glycoprotein IIb/IIIa polymorphism HPA-3 b/b is associated with increased risk of ischemic stroke in patients under 60 years of age. Med Sci Mon Int Med J Exp Clin Res 2012;18:CR19–24. https://doi.org/10.12659/msm.882195.Search in Google Scholar PubMed PubMed Central

Received: 2022-03-31
Accepted: 2022-07-11
Published Online: 2022-08-08
Published in Print: 2022-09-27

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The relevance of establishing method-dependent decision thresholds of serum folate in pregnancy and lactation: when the laboratory stewardship meets the health-care needs
  4. Reviews
  5. Strategies to minimise the current disadvantages experienced by women in faecal immunochemical test-based colorectal cancer screening
  6. What is the impact of circulating histones in COVID-19: a systematic review
  7. Mini Review
  8. Diagnostic utility of pleural cell-free nucleic acids in undiagnosed pleural effusions
  9. Guidelines and Recommendations
  10. Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
  11. Genetics and Molecular Diagnostics
  12. Detection of DNA copy number alterations by matrix-assisted laser desorption/ionization time-of-flight mass spectrometric analysis of single nucleotide polymorphisms
  13. General Clinical Chemistry and Laboratory Medicine
  14. Fifty years of newborn screening for congenital hypothyroidism: current status in Australasia and the case for harmonisation
  15. Commutability assessment of reference materials for homocysteine
  16. External quality assessment for detection of methylated Syndecan 2 (SDC2) in China
  17. Patient-based real-time quality control for quantitative hepatitis B virus DNA test using moving rate of positive and negative patient results
  18. Performance of HDL-C measurements assessed by a 4-year trueness-based EQA/PT program in China
  19. Two-site evaluation of the Roche Elecsys Vitamin D total III assay
  20. A novel point-of-care device accurately measures thyrotropin in whole blood, capillary blood and serum
  21. IgA rheumatoid factor in rheumatoid arthritis
  22. Reference Values and Biological Variations
  23. Reference intervals of 14 biochemical markers for children and adolescence in China: the PRINCE study
  24. Chinese normotensive and essential hypertensive reference intervals for plasma aldosterone and renin activity by liquid chromatography-tandem mass spectrometry
  25. Biological variation estimates obtained from Chinese subjects for 32 biochemical measurands in serum
  26. Cancer Diagnostics
  27. Testosterone analysis in castrated prostate cancer patients: suitability of the castration cut-off and analytical accuracy of the present-day clinical immunoassays
  28. Cardiovascular Diseases
  29. Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics
  30. Platelet count and clinical outcomes among ischemic stroke patients with endovascular thrombectomy in DIRECT-MT
  31. Infectious Diseases
  32. Measurement of anti SARS-CoV-2 RBD IgG in saliva: validation of a highly sensitive assay and effects of the sampling collection method and correction by protein
  33. Letters to the Editors
  34. The simple reproducibility of a measurement result does not equal its overall measurement uncertainty
  35. Complexity of serological assays and misunderstandings of WHO International Units
  36. Ct values of different SARS CoV2 variants: a single center observational study from Innsbruck, Austria
  37. Alignment of the new generation of Abbott Alinity γ-glutamyltransferase assay to the IFCC reference measurement system should be improved
  38. Thermal and chronological stability of monocyte distribution width (MDW), the new biomarker for sepsis
  39. Two comments for the current commutability assessment
  40. Plasma neurofilament light chain in Chinese children with later-onset spinal muscular atrophy
https://doi.org/10.1515/cclm-2022-0317
Keywords for this article
acute ischemic stroke; alteplase; endovascular thrombectomy; platelet count; prognosis

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The relevance of establishing method-dependent decision thresholds of serum folate in pregnancy and lactation: when the laboratory stewardship meets the health-care needs
  4. Reviews
  5. Strategies to minimise the current disadvantages experienced by women in faecal immunochemical test-based colorectal cancer screening
  6. What is the impact of circulating histones in COVID-19: a systematic review
  7. Mini Review
  8. Diagnostic utility of pleural cell-free nucleic acids in undiagnosed pleural effusions
  9. Guidelines and Recommendations
  10. Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
  11. Genetics and Molecular Diagnostics
  12. Detection of DNA copy number alterations by matrix-assisted laser desorption/ionization time-of-flight mass spectrometric analysis of single nucleotide polymorphisms
  13. General Clinical Chemistry and Laboratory Medicine
  14. Fifty years of newborn screening for congenital hypothyroidism: current status in Australasia and the case for harmonisation
  15. Commutability assessment of reference materials for homocysteine
  16. External quality assessment for detection of methylated Syndecan 2 (SDC2) in China
  17. Patient-based real-time quality control for quantitative hepatitis B virus DNA test using moving rate of positive and negative patient results
  18. Performance of HDL-C measurements assessed by a 4-year trueness-based EQA/PT program in China
  19. Two-site evaluation of the Roche Elecsys Vitamin D total III assay
  20. A novel point-of-care device accurately measures thyrotropin in whole blood, capillary blood and serum
  21. IgA rheumatoid factor in rheumatoid arthritis
  22. Reference Values and Biological Variations
  23. Reference intervals of 14 biochemical markers for children and adolescence in China: the PRINCE study
  24. Chinese normotensive and essential hypertensive reference intervals for plasma aldosterone and renin activity by liquid chromatography-tandem mass spectrometry
  25. Biological variation estimates obtained from Chinese subjects for 32 biochemical measurands in serum
  26. Cancer Diagnostics
  27. Testosterone analysis in castrated prostate cancer patients: suitability of the castration cut-off and analytical accuracy of the present-day clinical immunoassays
  28. Cardiovascular Diseases
  29. Point-of-care high-sensitivity troponin-I analysis in capillary blood for acute coronary syndrome diagnostics
  30. Platelet count and clinical outcomes among ischemic stroke patients with endovascular thrombectomy in DIRECT-MT
  31. Infectious Diseases
  32. Measurement of anti SARS-CoV-2 RBD IgG in saliva: validation of a highly sensitive assay and effects of the sampling collection method and correction by protein
  33. Letters to the Editors
  34. The simple reproducibility of a measurement result does not equal its overall measurement uncertainty
  35. Complexity of serological assays and misunderstandings of WHO International Units
  36. Ct values of different SARS CoV2 variants: a single center observational study from Innsbruck, Austria
  37. Alignment of the new generation of Abbott Alinity γ-glutamyltransferase assay to the IFCC reference measurement system should be improved
  38. Thermal and chronological stability of monocyte distribution width (MDW), the new biomarker for sepsis
  39. Two comments for the current commutability assessment
  40. Plasma neurofilament light chain in Chinese children with later-onset spinal muscular atrophy
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 23.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2022-0317/html
Scroll to top button