The effect of the mean platelet volume on short-term prognosis in acute ischemic stroke patients who underwent intravenous thrombolytic therapy

Yıl 2024, Cilt: 37 Sayı: 2, 152 - 156, 31.05.2024

Çisil İrem Özgenç Biçer , Işıl Kalyoncu Aslan , Eren Gözke

https://doi.org/10.5472/marumj.1485342

Öz

Objective: To evaluate the effect of the mean platelet volume (MPV), on the short-term prognosis and bleeding complications of acute
ischemic stroke patients who underwent intravenous tissue plasminogen activator (IV-tPA) treatment.
Patients and Methods: Between 01.01.2018 and 01.06.2021, 314 ischemic stroke patients who applied to our clinic with acute
neurological deficit were included in the study retrospectively. Alteplase was administered as IV-tPA treatment for 1 hour. MPV value
was measured before the treatment and was evaluated as the main parameter. The patients were examined under 4 groups (≤8.8fL, >8.8
– ≤9.9, >9.9-≤10.8, >10.8fL) according to their MPV values, and age, gender, comorbidities, and treatment initiation parameters were
standardized by statistical methods. It was compared whether there was a significant difference between the MPV groups in terms
of short-term prognosis according to the admission National Institutes of Health Stroke Scale (NIHSS) scores and discharge NIHSS
scores and also bleeding complications.
Results: A total of 314 patients, 145 women with a mean age of 76.7±13.0, and 169 men with a mean age of 66.3±13.1, were included
in the study. 31 patients (9.9%) died before discharge. The mean MPV value was 9.64±1.15fL and the mean NIHSS score was 9.1±4.9
at admission, and the mean NIHSS score was 4.3±4.7 at discharge. When the NIHSS difference between admission and discharge was
compared in the 4 groups, it was found that the prognosis was better in Group 3 with MPV >9.9-≤10.8 compared to Groups 1 and
4. (p=0.002; p<0.01). Despite this, it was seen that low or high MPV values could not be considered as a prognostic factor alone in
patients who received IV-tPA treatment, since, there was no significant difference between the 3rd group and the 2nd group in terms
of NIHSS decrease and the 4th group had a worse prognosis than the 3rd group.
There was no statistical significance between MPV groups in terms of hemorrhage complications (p value for intracerebral,
gastrointestinal, urogenital hemorrhage complications were 0.540, 0.980, 0.783, respectively).
Conclusion: In our study, it was revealed that MPV value, is not an independent risk factor in patients with acute ischemic stroke
receiving IV-tPA treatment and cannot be used as a prognostic marker.

Anahtar Kelimeler

Stroke, Prognosis, MPV, IV-tPA

Kaynakça

• Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st Century. Stroke 2013; 44: 2064-89. doi: 10.1161/str.0b013e318296aeca
• Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 Age groups in 1990 and 2010: A systematic analysis for the global burden of disease study 2010. The Lancet 2012; 380: 2095-128. doi: 10.1016/s0140-6736(12)61728-0
• Dębiec A, Pogoda-Wesołowska A, Piasecki P, et al. Mean platelet volume as a potential marker of large vessel occlusion and predictor of outcome in acute ischemic stroke patients treated with reperfusion therapy. Life 2021; 11:469. doi:10.3390/ life11060469
• Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation 2020; 141. doi:10.1161/ cir.000.000.0000000757.
• Loo B van, Martin JF. 6 megakaryocytes and platelets in vascular disease. Baillieres Clin Haematol 1997; 10: 109- 23. doi: 10.1016/s0950-3536(97)80053-4
• Muscari A, Puddu GM, Cenni A, et al. Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes. Thromb Res 2009; 123: 587-91. doi: 10.1016/j. thromres.2008.03.025
• Staszewski J, Pogoda A, Data K, et al. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin Interv Aging 2019; Volume 14: 493-503. doi: 10.2147/cia.s195451
• Oji S, Tomohisa D, Hara W, et al. Mean platelet volume is associated with early neurological deterioration in patients with branch atheromatous disease: Involvement of platelet activation. J Stroke Cerebrovasc Dis 2018; 27: 1624-31. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.012
• Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999; 340: 115-26. doi: 10.1056/nejm199.901.143400207
• Baidildinova G, Nagy M, Jurk K, et al. Soluble platelet release factors as biomarkers for cardiovascular disease. Front Cardiovasc Med 2021; 8. doi:10.3389/fcvm.2021.684920.
• Bath PM, Butterworth RJ. Platelet size. Blood Coagul Fibrinolysis 1996; 7: 157-61. doi: 10.1097/00001.721.199603000- 00011
• Arévalo-Lorido JC, Carretero-Gómez J, Álvarez-Oliva A, et al. Mean platelet volume in acute phase of ischemic stroke, as predictor of mortality and functional outcome after 1 year. J Stroke Cerebrovasc Dis 2013; 22:297303. doi: 10.1016/j. jstrokecerebrovasdis.2011.09.009
• Bath P, Algert C, Chapman N, et al. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke 2004; 35: 622- 6. doi: 10.1161/01.str.000.011.6105.26237.ec
• Van Gijn J. The progress trial: Preventing strokes by lowering blood pressure in patients with cerebral ischemia. Stroke 2002; 33: 319-20. doi: 10.1161/str.33.1.319
• D’erasmo E, Alıbertı G, Celı Fs, et al. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J Intern Med 1990; 227: 11-4. doi: 10.1111/j.1365- 2796.1990.tb00111.x
• Kosalram J. A study on mean platelet volume in acute ischemic stroke. J Med Sci Clin Res 2017; 5. doi:10.18535/ jmscr/v5i10.141.
• Ntaios G, Gurer O, Faouzi M, et al. Mean platelet volume in the early phase of acute ischemic stroke is not associated with severity or functional outcome. Cerebrovasc Dis 2010; 29: 484-9. doi: 10.1159/000297964
• Khandelwal P, Martínez-Pías E, Bach I, et al. Severe epistaxis after tissue plasminogen activator administration for acute ischemic stroke in SARS-COV-2 infection. Brain Circ 2021; 7: 135. doi: 10.4103/bc.bc_17_21