Trombosit İndekslerinin Trombotik ve Embolik İskemik İnme Ayırımındaki Rolü

Öz

Giriş ve Amaç: Kritik bir klinik tablo olan iskemik inme, trombotik ve embolik alt tipler olarak sınıflandırılabilir. Bu alt tipler arasındaki trombosit indekslerindeki farklılıkların anlaşılması, önemli bilgiler sağlayabilir. Gereç ve Yöntemler: Bu kesitsel çalışmaya, acil serviste akut iskemik inme tanısı almış hastalar dahil edilmiştir. Trombotik ve embolik alt tipler; demografik özellikler, eşlik eden hastalıklar, kan test sonuçları ve trombosit indeksleri açısından karşılaştırılmıştır. Çalışmanın birincil çıktısı, trombotik ve embolik iskemik inme hastaları arasında trombosit indekslerinin karşılaştırılmasıdır. Bulgular: Çalışmaya toplam 233 hasta dahil edilmiş olup, bunların 130’u (%55,8) trombotik, 103’ü (%44,2) embolik iskemik inme tanısı almıştır. Trombotik inme hastaları daha ileri yaşta bulunmuş (p=0,01) ve koroner arter hastalığı sıklığı daha yüksek saptanmıştır (p=0,019). Öte yandan, embolik inme hastalarında atriyal fibrilasyon oranı anlamlı derecede daha yüksek bulunmuştur (p<0,001). Trombotik inme olgularında trombosit dağılım genişliği (PDW) [17 (16,3 – 17,8) vs. 13,7 (11,8 – 16), p<0,001] ve ortalama trombosit hacmi (MPV) [10,8 ± 1,4 vs. 9,71 ± 1,24, p<0,001] değerleri, embolik inme olgularına kıyasla anlamlı derecede yüksek bulunmuştur. Trombosit sayısı (p=0,352) ve plateletkrit (p=0,106) değerleri ise gruplar arasında anlamlı farklılık göstermemiştir. Sonuç: Bu çalışma, trombotik ve embolik iskemik inme alt tipleri arasında belirgin trombosit indeks desenleri olduğunu ortaya koymaktadır. PDW ve MPV değerleri trombotik inme hastalarında daha yüksek saptanırken, trombosit sayısı ve plateletkrit açısından anlamlı fark gözlenmemiştir. Elde edilen bulgular, PDW ve MPV değerlerindeki artışın trombotik inmelerde artmış trombosit aktivasyonu ile ilişkili olabileceğini düşündürmektedir.

Anahtar Kelimeler

• İskemik inme
• trombotik inme
• embolik inme
• trombosit indeksleri
• inme sınıflandırması
• ortalama trombosit hacmi
• trombosit dağılım genişliği
• inme patofizyolojisi

Platelet Indices in Distinguishing Thrombotic vs Embolic Ischemic Stroke

Öz

Aim; Ischemic stroke, a critical condition, can be categorized into thrombotic and embolic subtypes. Understanding the differences in platelet indices between these subtypes can provide valuable insights. Method; This cross-sectional study included patients diagnosed with acute ischemic stroke in the emergency department. Thrombotic and embolic subtypes were compared in terms of demographics, comorbidities, blood results and platelet indices. The primary outcome of the study was comparison of platelet indices between thrombotic and embolic ischemic stroke patients. Results; The study included a total of 233 patients, with 130 (55.8%) diagnosed with thrombotic ischemic stroke and 103 (44.2%) with embolic ischemic stroke. Thrombotic stroke patients were older in age (p=0.01), had higher rates of coronary artery disease (p=0.019). But the embolic stroke patients and higher rate of atrial fibrillation (p<0.001). Thrombotic stroke cases demonstrated significantly higher platelet distribution width (PDW) values (17 [16.3 – 17.8] vs. 13.7 [11.8 – 16], p < 0.001) and mean platelet volume (MPV) values (10.8 ± 1.4 vs. 9.71 ± 1.24, p < 0.001) compared to embolic stroke cases. The platelet count (p=0.352) and plateletcrit (p=0.106) did not differ significantly among groups. Conclusion; This study reveals distinctive platelet index patterns between thrombotic and embolic ischemic stroke subtypes. While PDW and MPV were higher in thrombotic patients, platelet count and plateletcrit were not significantly different between groups. The findings suggest a potential association between elevated PDW and MPV values and heightened platelet activation in thrombotic strokes.

Anahtar Kelimeler

• Ischemic stroke
• thrombotic stroke
• embolic stroke
• platelet indices
• stroke classification
• mean platelet volume
• platelet distribution width
• stroke pathophysiology

Kaynakça

1. 1. Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke. 2022;17:18–29.
2. 2. Katan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38:208–11.
3. 3. Adams HP, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999;53:126–31.
4. 4. Hui C, Tadi P, Patti L. Ischemic Stroke. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
5. 5. Ashkenazi L, Toledano R, Novack V, EIluz E, Abu-Salamae I, Ifergane G. Emergency Department Companions of Stroke Patients. Medicine (Baltimore). 2015;94:e520.
6. 6. Chen C-Y, Lin P-T, Wang Y-H, Syu R-W, Hsu S-L, Chang L-H, et al. Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults. J Chin Med Assoc. 2021;84:930–6.
7. 7. Huang W-Y, Chang C-W, Chen C-M, Chen K-H, Chang C-H, Wu H-C, et al. Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome. BMC Nephrol. 2021;22:213.
8. 8. Boulouis G, Lauer A, Siddiqui AK, Charidimou A, Regenhardt R, Viswanathan A, et al. Abstract TP6: Factors Influencing Infarct Progression During Ischemic Stroke Patients Transfer: Collaterals Lost is Brain Lost. Stroke. 2017;48 suppl_1:ATP6–ATP6.

9. 9. Ingall T. Stroke--incidence, mortality, morbidity and risk. J Insur Med. 2004;36:143–52.
10. 10. Zarmehri B, shahi B, Rahmani S, Dehghan Tafti F, Foroughian M. Association of platelet count and mean platelet volume (MPV) index with types of stroke. Caspian J Intern Med. 2020;11:398–402.
11. 11. Mohamed A-AB, Elnady HM, Alhewaig HK, Moslem Hefny H, Khodery A. The mean platelet volume and plateletcrit as predictors of short-term outcome of acute ischemic stroke. Egypt J Neurol Psychiatr Neurosurg. 2019;55:4.
12. 12. Bath P, Algert C, Chapman N, Neal B. Association of Mean Platelet Volume With Risk of Stroke Among 3134 Individuals With History of Cerebrovascular Disease. Stroke. 2004;35:622–6.
13. 13. Fuentes Q E, Fuentes Q F, Andrés V, Pello OM, Font de Mora J, Palomo G I. Role of platelets as mediators that link inflammation and thrombosis in atherosclerosis. Platelets. 2013;24:255–62.
14. 14. Jin Y, Li D, Sun T, Du Y, Gao Y, Ding R, et al. Pathological Features of Enterovirus 71-Associated Brain and Lung Damage in Mice Based on Quantitative Proteomic Analysis. Front Microbiol. 2021;12:663019.
15. 15. Ibrahim F, Murr N. Embolic Stroke. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
16. 16. Koltai K, Kesmarky G, Feher G, Tibold A, Toth K. Platelet Aggregometry Testing: Molecular Mechanisms, Techniques and Clinical Implications. Int J Mol Sci. 2017;18:1803.
17. 17. Shen C-L, Wu Y-F. Flow cytometry for evaluating platelet immunophenotyping and function in patients with thrombocytopenia. Tzu Chi Med J. 2022;34:381–7.
18. 18. Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb). 2016;26:178–93.
19. 19. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. 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;24:35–41.
20. 20. Feinberg WM, Erickson LP, Bruck D, Kittelson J. Hemostatic Markers in Acute Ischemic Stroke. Stroke. 1996;27:1296–300.
21. 21. Harpaz D, Seet RCS, Marks RS, Tok AIY. Blood-Based Biomarkers Are Associated with Different Ischemic Stroke Mechanisms and Enable Rapid Classification between Cardioembolic and Atherosclerosis Etiologies. Diagnostics (Basel). 2020;10:804.
22. 22. Ghoshal K, Bhattacharyya M. Overview of Platelet Physiology: Its Hemostatic and Nonhemostatic Role in Disease Pathogenesis. ScientificWorldJournal. 2014;2014:781857.
23. 23. Xu XR, Zhang D, Oswald BE, Carrim N, Wang X, Hou Y, et al. Platelets are versatile cells: New discoveries in hemostasis, thrombosis, immune responses, tumor metastasis and beyond. Critical Reviews in Clinical Laboratory Sciences. 2016;53:409–30.
24. 24. Harshfield EL, Sims MC, Traylor M, Ouwehand WH, Markus HS. The role of haematological traits in risk of ischaemic stroke and its subtypes. Brain. 2020;143:210–21.
25. 25. Bayar N, Küçükseymen S, Erkal Z, Güven R, Köklü E, Üreyen ÇM, et al. Relationship between mean platelet volume and ischemic stroke in patients with patent foramen ovale. Turk Kardiyol Dern Ars. 2017;45:9–15.
26. 26. Kushner A, West WP, Khan Suheb MZ, Pillarisetty LS. Virchow Triad. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
27. 27. Kim J, Kim YD, Song T-J, Park JH, Lee HS, Nam CM, et al. Red blood cell distribution width is associated with poor clinical outcome in acute cerebral infarction. Thromb Haemost. 2012;108:349–56.
28. 28. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009;169:515–23.
29. 29. Shams Vahdati S, Ala A, Vahed N, Mohammadi S, Ameli H. Complete Blood Count Parameters as Prognostic Factor of Stroke: A Systematic Review. Basic Clin Neurosci. 2022;13:745–54.
30. 30. Gao F, Chen C, Lyu J, Zheng J, Ma X-C, Yuan X-Y, et al. Association between platelet distribution width and poor outcome of acute ischemic stroke after intravenous thrombolysis. Neuropsychiatr Dis Treat. 2018;14:2233–9.
31. 31. Bancroft AJ, Abel EW, Mclaren M, Belch JJ. Mean platelet volume is a useful parameter: a reproducible routine method using a modified Coulter thrombocytometer. Platelets. 2000;11:379–87.
32. 32. Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets. 2016;27:607–12.
33. 33. Kamath S, Blann AD, Lip GY. Platelet activation: assessment and quantification. Eur Heart J. 2001;22:1561–71.
34. 34. Sadeghi F, Kovács S, Zsóri KS, Csiki Z, Bereczky Z, Shemirani AH. Platelet count and mean volume in acute stroke: a systematic review and meta-analysis. Platelets. 2020;31:731–9.
35. 35. Demirin H, Ozhan H, Ucgun T, Celer A, Bulur S, Cil H, et al. Normal range of mean platelet volume in healthy subjects: Insight from a large epidemiologic study. Thromb Res. 2011;128:358–60.
36. 36. Weymann A, Ali-Hasan-Al-Saegh S, Sabashnikov A, Popov A-F, Mirhosseini SJ, Nombela-Franco L, et al. Platelets Cellular and Functional Characteristics in Patients with Atrial Fibrillation: A Comprehensive Meta-Analysis and Systematic Review. Med Sci Monit Basic Res. 2017;23:58–86.
37. 37. Lin W, Wu Y, Lu X, Hu Y. Association between mean platelet volume and pulmonary embolism: a systematic review and meta-analysis. Aging (Albany NY). 2021;13:17253–73.
38. 38. Sato Y, Yoshihisa A, Watanabe K, Hotsuki Y, Kimishima Y, Yokokawa T, et al. Association between platelet distribution width and prognosis in patients with heart failure. PLoS One. 2020;15:e0244608.
39. 39. Li T, Jin J, Meng Z, Zhang W, Li Y, Yu X, et al. The different associations between platelet distribution width and hypertension subtypes in males and females. Biosci Rep. 2020;40:BSR20201747.
40. 40. Tatlıparmak AC, Dikme Ö, Dikme Ö, Topaçoğlu H. Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding. PeerJ. 2022;10:e14061.
41. 41. Peng F, Zheng W, Li F, Wang J, Liu Z, Chen X, et al. Elevated mean platelet volume is associated with poor outcome after mechanical thrombectomy. J Neurointerv Surg. 2018;10:25–8.
42. 42. Cetin M, Bakirci EM, Baysal E, Tasolar H, Balli M, Cakici M, et al. Increased platelet distribution width is associated with ST-segment elevation myocardial infarction and thrombolysis failure. Angiology. 2014;65:737–43.
43. 43. Adam G, Kocak E, Özkan A, Reşorlu M, Çınar C, Bozkaya H, et al. Evaluation of platelet distribution width and mean platelet volume in patients with carotid artery stenosis. Angiology. 2015;66:375–8.
44. 44. 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke. Canadian Stroke Best Practices. https://www.strokebestpractices.ca/en/recommendations/acute-stroke-management/emergency-department-evaluation-and-management/. Accessed 28 Aug 2023.
45. 45. Tzur I, Barchel D, Izhakian S, Swarka M, Garach-Jehoshua O, Krutkina E, et al. Platelet distribution width: a novel prognostic marker in an internal medicine ward. J Community Hosp Intern Med Perspect. 2019;9:464–70.
46. 46. Yang M, Pan Y, Li Z, Yan H, Zhao X, Liu L, et al. Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II. Frontiers in Neurology. 2019;10.
47. 47. Du J, Wang Q, He B, Liu P, Chen J-Y, Quan H, et al. Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. Int J Lab Hematol. 2016;38:233–9.