Doctors who agonize over how best to treat stroke victims may be guided in the future by the results of a study conducted by a team of researchers at the University of Oklahoma Health Sciences Center.
Calin I. Prodan, M.D., with the OU College of Medicine's Department of Neurology and Veterans Affairs Medical Center, led the research effort. He said it is clear that larger strokes, in general, are more dangerous than smaller ones; and many stroke victims have a second stroke within a year of their first one. The question is, how can doctors know which patients are at greater risk for a second stroke?
Researchers believed one indicator might be the percentage of coated-platelets. These are a subset of procoagulant platelets first described by Dr. George Dale with the OU Department of Medicine. It is these platelets that coagulate or clot the fastest, blocking blood vessels to the brain.
Normal human blood contains about 30 percent of coated-platelets. Stroke victims, however, have much higher percentages of coated-platelets - between 40 percent and 60 percent.
OU researchers set out to determine if the level of coated-platelets measured when the patient is admitted to the hospital for an initial stroke would help predict whether he or she would have a second stroke within a year.
The team measured coated-platelet levels in 180 stroke victims and followed their case histories for a year. Stroke patients in the study were assigned to one of three groups based upon their levels of coated-platelets upon admission to the hospital.
The results were then analyzed with assistance from Julie Stoner, Ph.D., and Linda Cowan, Ph.D., of the OU College of Public Health.
Twenty of the patients in the study suffered a subsequent stroke within a year, and 19 of those patients had medium or high coated-platelet levels. Only one recurrent stroke patient had low coated-platelet levels.
"What the results showed was that stroke patients with higher levels of this subset of procoagulant platelets are much more likely to have a second stroke within a period of a year,” said Prodan.
For doctors treating stroke victims, he said the findings should help in determining the balance between risks and benefits as well as the desirability of aggressive as opposed to more conservative treatment.
"If you know that this group of patients is much more likely to have another stroke within a year, then you're going to be much more aggressive in treating and managing those patients who are higher risk, compared to the ones who are lower risk," he said.
Prodan said the study is a good example of "translational" research, that is, research that begins in the laboratory, moves into the clinical world, and then returns to scientific study, where specialists from a range of medical backgrounds can evaluate the results.
"It's kind of like standing on a taller mountain," he said. "You can see farther away."
The team next plans to utilize coated-platelet levels as a potential predictor of subsequent stroke in a larger group of patients. The goal is to build a model that will enable doctors to identify those patients at greater risk for recurrent stroke and also those who are more likely to benefit from aggressive stroke prevention treatment with the fewest side effects.
"So in the end it may lead us to an individualized risk model as well as an individualized treatment protocol," Prodan said.
The study was financed by grants from the U.S. Department of Veterans Affairs Clinical Science Research and Development Service and the American Heart Association.
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