LAUSR

Introduction: Elevated levels of coated-platelets (a subset of procoagulant platelets) are often associated with acute ischemic stroke (AIS). Diabetes mellitus (DM) and chronic inflammation are both known risks factor for AIS. Elevated neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) are also often seen in the setting of acute myocardial infarction and AIS. However, the relationship between prothrombotic, dysglycemic and proinflammatory states in AIS is incompletely characterized. Hypothesis: To investigate whether elevated coated-platelet levels in AIS patients with chronic hyperglycemia is associated with proinflammatory states. Methods: The present cohort consists of patients with AIS or transient ischemic attack (TIA) due to large-artery disease over the period of one year. Coated-platelet levels were assayed upon admission. Glycated hemoglobin (HbA1c) and leukocyte count with differential were obtained through retrospective chart review. Study population was subcategorized into DM (HbA1c >6.4 and/or history of DM), prediabetic (PD, HbA1c 5.7-6.4) and non-diabetic (ND, HbA1c <5.7). Inter-relationship was assessed using linear regression models. Results: We recruited 47 AIS/TIA patients, with an average age of 67.3±8.1 years and 17/47 (36.2%) being current smokers. Thirty of 47 patients (63.8%) were diabetic with 23 patients having HbA1c levels >6.4. Higher coated-platelet levels were associated with higher lymphocyte count for the entire group (r=+0.375; p=0.0094) and also for the patients with HbA1c >6.4 (r=+0.516; p=0.012; n=23). Although PLR and HbA1c >6.4 showed a positive correlation (r=+0.42; p=0.046; n=23) in DM patients, this was not observed among DM patients with HbA1c <6.4. Conclusion: Our study demonstrates positive correlations between elevated coated-platelets and lymphocyte count and between PLR and HbA1c in AIS/TIA patients with HbA1c >6.4. This alludes to a synergistic role for procoagulant and proinflammatory states in chronically dysglycemic AIS/TIA patients.