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Remote platelet function testing using P-selectin expression in patients with recent cerebral ischaemia on clopidogrel

Jason Philip Appleton, Carla Richardson, Natalia Dovlatova, Jane May, Nikola Sprigg, Stan Heptinstall, Philip M Bath
DOI: 10.1136/svn-2020-000346 Published 25 March 2021
Jason Philip Appleton
1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
2 Stroke Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Carla Richardson
1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
2 Stroke Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Natalia Dovlatova
3 Platelet Solutions Ltd, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
4 Platelet Research Group, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Jane May
3 Platelet Solutions Ltd, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
4 Platelet Research Group, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Nikola Sprigg
1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
2 Stroke Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Stan Heptinstall
3 Platelet Solutions Ltd, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
4 Platelet Research Group, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Philip M Bath
1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
2 Stroke Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
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    Figure 1

    P-selectin surface expression in response to arachidonic acid. MF, median fluorescence.

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    Figure 2

    P-selectin surface expression in response to ADP. MF, median fluorescence.

Tables

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  • Table 1

    Baseline characteristics of participants

    AllClopidogrel onlyAspirin+clopidogrelP value
    n (%)62 (100.0)59 (95.2)3 (4.8)
    Male (%)33 (53.2)33 (55.9)00.058
    Age, years63.7 (13.7)63.0 (13.5)78.0 (8.9)0.06
    Preindex event
     Stroke (%)9 (14.5)8 (13.6)1 (33.3)0.34
     TIA (%)8 (12.9)6 (10.2)2 (66.7)0.004
     IHD (%)6 (9.7)5 (8.5)1 (33.3)0.16
     Diabetes (%)11 (17.7)10 (16.9)1 (33.3)0.47
     Smoking (%)9 (14.5)9 (15.3)00.74
    Index event
     Ischaemic stroke (%)44 (71.0)42 (71.2)2 (66.7)0.87
     TIA (%)18 (29.0)17 (28.8)1 (33.3)0.87
     Thrombolysis (%)4 (6.5)4 (6.8)00.64
     Length of stay, days1 [1,3] (0–60)1 [0,3] (0–60)2 [−] (1-7)0.25
    At recruitment
     Time from index event, days49 [35,75] (1–285)52 [36,76] (1–285)1 [−] (1–22)0.006
     mRS0 [0,1]0 [0,1]0 [−]0.89
     On clopidogrel (%)62 (100)59 (100)3 (100)–
     Time on clopidogrel, days50 [35, 76] (8–1878)48 [35, 69] (8–1878)313 [−] (8–962)0.41
     On aspirin (%)3 (4.8)03 (100)–
     Treated hypertension (%)43 (69.4)40 (67.8)3 (100)0.24
     Treated hypercholesterolaemia (%)59 (95.2)56 (94.9)3 (100)0.69
     Proton pump inhibitor (%)19 (30.6)17 (28.8)2 (66.7)0.17
     Systolic BP, mm Hg135.7 (19.5)134.9 (19.3)150.0 (22.5)0.21
     Diastolic BP, mm Hg76.3 (13.5)76.6 (13.7)71.7 (7.8)0.26
    Bleeding history on antiplatelet(s)
     Minor bleeding (%)17 (27.4)17 (28.8)00.28
     Major bleeding (%)000–
    • Data are number (%), mean (SD), median [IQR], (min–max); comparison between clopidogrel versus aspirin+clopidogrel groups by χ2 test, Kruskal-Wallis test or one-way analysis of variance.

    • Sixty-three participants recruited but 1 had no data collected.

    • BP, blood pressure; IHD, ischaemic heart disease; mRS, modified Rankin Scale; TIA, transient ischaemic attack.

  • Table 2

    P-selectin in response to arachidonic acid (AA, aspirin test) and ADP (clopidogrel test)

    AllClopidogrel onlyAspirin +clopidogrelP value
    AA MF
     Number (%)62 (100)59 (95.2)3 (4.8)–
     Mean (SD)590 (330)612 (323)160 (118)0.020
     Median [IQR]528 [317, 834]547 [375,851]103 [−]0.013
     >500 (%)34 (54.8)34 (57.6)00.050
    ADP MF
     Number (%)62 (100)59 (95.2)3 (4.8)–
     Mean (SD)493 (266)498 (269)392 (202)0.51
     Median [IQR]429 [303, 656]425 [307, 656]502 [−]0.54
     >860 (%)7 (11.3)7 (11.9)00.53
    • Data are number (%), median [IQR] or mean (SD); comparisons by χ2 test, Kruskal-Wallis test or one-way analysis of variance.

    • MF, median fluorescence.

  • Table 3

    P-selectin in response to arachidonic acid (AA, aspirin test) and ADP (clopidogrel test) by minor or no bleeding

    AllMinor bleedingNo bleedingP value
    AA MF
     Number (%)62 (100)17 (27.4)45 (72.6)–
     Mean (SD)590 (330)644 (280)569 (348)0.43
     Median [IQR]528 [317, 834]691 [438, 791]495 [296, 870]0.28
     >500 (%)34 (54.8)12 (70.6)22 (48.9)0.13
    ADP MF
     Number (%)62 (100)17 (27.4)45 (72.6)–
     Mean (SD)493 (266)481 (213)498 (286)0.83
     Median [IQR]429 [303, 656]444 [321, 685]425 [285, 656]0.88
     >860 (%)7 (11.3)07 (15.6)0.08
    • Data are number (%), median [IQR] or mean (SD); comparisons by χ2 test, Kruskal-Wallis test or one-way analysis of variance.

    • MF, median fluorescence.

  • Table 4

    Correlations between baseline P-selectin clopidogrel test and clinical outcomes after day 90

    rP value
    Number (%)19 (30.2)–
    mRS0.1640.50
    Barthel index−0.2080.39
    EQ-VAS0.0750.76
    t-MMSE−0.0600.81
    TICS-M−0.2310.34
    Verbal fluency−0.2350.33
    Zung−0.1250.61
    • Data are number (%), r with two-sided p values using Spearman correlation.

    • EQ-VAS, European Quality of Life Visual Analogue Scale; mRS, modified Rankin Scale; TICS-M, Modified Telephone Interview for Cognition Scale; t-MMSE, telephone Mini-Mental State Examination.

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Remote platelet function testing using P-selectin expression in patients with recent cerebral ischaemia on clopidogrel
Jason Philip Appleton, Carla Richardson, Natalia Dovlatova, Jane May, Nikola Sprigg, Stan Heptinstall, Philip M Bath
Stroke and Vascular Neurology Mar 2021, 6 (1) 103-108; DOI: 10.1136/svn-2020-000346

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Remote platelet function testing using P-selectin expression in patients with recent cerebral ischaemia on clopidogrel
Jason Philip Appleton, Carla Richardson, Natalia Dovlatova, Jane May, Nikola Sprigg, Stan Heptinstall, Philip M Bath
Stroke and Vascular Neurology Mar 2021, 6 (1) 103-108; DOI: 10.1136/svn-2020-000346
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Remote platelet function testing using P-selectin expression in patients with recent cerebral ischaemia on clopidogrel
Jason Philip Appleton, Carla Richardson, Natalia Dovlatova, Jane May, Nikola Sprigg, Stan Heptinstall, Philip M Bath
Stroke and Vascular Neurology Mar 2021, 6 (1) 103-108; DOI: 10.1136/svn-2020-000346
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