Aspirin Resistance Among Patients with Recurrent Ischaemic Stroke,and Outcome of Patients at 120 Days with Alternative Antiplatelet: A Cohort Study in a Tertiary Care Hospital in Bangladesh

Abstract

Background

Aspirin resistance due to integrin gene defects (ITGB3) is one of the risk factors for recurrent ischaemic stroke.

Objective

The study aims to know about aspirin resistance due to ITGB3 gene polymorphism (PlA1/A2), factors associated with it and the outcome of the patients at 4 months after reinstitution of an alternative antiplatelet.

Methods

This prospective cohort study was conducted from February 2022 to December 2022. All recurrent ischaemic stroke patients who were on aspirin were included. Enrolled patients were followed up for 120 days to see clinical outcomes. To identify the ITGB3 gene, DNA was extracted from peripheral blood cells, thereafter polymerase chain reaction was done to amplify the DNA. Clinical outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Multivariate regression analysis was done for factor analysis.

Result

A total of 145 patients were enrolled, among them, 30 (20.7%) had aspirin resistance (ITGB3 gene defect). Out of 30 patients, 17 (57%) and 13 (43%) had single and double gene defects, respectively. The NIHSS score among aspirin-resistant group was 14 [12-18], whereas in aspirin-sensitive group, it was 10 [6-15], = .03; frequency of stroke among aspirin-resistant group was 2.9 ± 0.5, whereas in aspirin-sensitive group, it was 2.1 ± 0.3, p < .001; Alberta Stroke Program Early Computed Tomography score at presentation was 8 [7-9] in aspirin-sensitive group, whereas in aspirin-resistant group, it was 7 [6-8], p = .01. The mortality rate was 10 (33.3%) in aspirin-resistant group, whereas in aspirin-sensitive group, it was 25 (21.7%), p = .03. The median mRS was 3 [2-5] in aspirin-resistant group and 2 [0-3] in aspirin-sensitive group, p = .02. In logistic regression, raised haemoglobin A1C (HbA1C) (OR 1.8, 95% CI [1.3-4.3], p < .001) and raised fasting plasma glucose (OR 2.9, 95% CI [1.9-4.5], p < .001) showed a significant association with aspirin resistance.

Conclusion

The frequency of aspirin resistance due to ITGB3 gene defect is high and significantly associated with an increased rate of recurrence, severity of stroke and large infarct. High fasting blood glucose and raised HbA1C were associated with aspirin resistance. The aspirin-resistant group had higher mortality and more functional disability than the aspirin-sensitive group.