Abstract P204: Stroke Topography Impacts Sleep Architecture in Post-Acute Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Stefanie N Howell ◽  
Stephanie E Robinson ◽  
Grace S Griesbach
Keyword(s):  
Ischemic Stroke ◽  
Rem Sleep ◽  
Sleep Efficiency ◽  
Sleep Architecture ◽  
Sleep Stages ◽  
Apnea Hypopnea Index ◽  
Close Monitoring ◽  
Stroke Patients ◽  
Significant Difference ◽  
The Impact

Introduction/Objective: Sleep-wake disturbances (SWDs) are common amongst stroke patients; however, little work has been done on the effect of stroke location on sleep architecture. The aim of this study was to investigate the impact of stroke topography on prevalence and severity of SWDs in the post-acute phase of ischemic stroke recovery. Methods: Ischemic stroke patients (n=55) were assessed for SWDs via overnight attended polysomnography in a post-acute rehabilitation setting. The mean age was 55 ± 1.4 years and mean latency from injury was 106 ± 11 days. Sleep measures included total sleep time (TST), sleep and REM latency, sleep efficiency, percent time in sleep stages, apnea/hypopnea index (AHI), wake after sleep onset (WASO), and arousal index. Patients who did not have at least four hours of TST were excluded. Stroke patients were identified as having supratentorial or infratentorial injuries. Results: Results showed a significant difference between supratentorial and infratentorial stroke in regards to sleep efficiency, REM sleep, and sleep apnea. Patients with infratentorial stroke (n=15) displayed significantly poorer sleep efficiency (F(1,53)=12.386, p<.001), decreased REM sleep (F(1,53)=5.944), p<.05) and higher AHI (F(1,53)=4.698, p<.05). In addition to displaying a decreased amount of REM, infratentorial stroke patients displayed significantly shorter bouts of REM (F(1,52)=7.482, p<.01). Neither age nor AHI were significantly correlated with the amount or duration of REM (p>.05). Conclusion: Infratentorial ischemic stroke patients display significant disruptions in sleep and may require close monitoring for sleep-wake disturbances in the post-acute period. REM sleep is particularly effected when compared to supratentorial ischemic stroke.

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

Abstract P417: Relationship Between Blood Pressure Variability and Sleep Architecture

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Xiaoyue Liu ◽  
Jeongok G Logan ◽  
Younghoon Kwon ◽  
Jennifer Lobo ◽  
Hyojung Kang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Eye Movement ◽  
Rem Sleep ◽  
Sleep Time ◽  
Sleep Architecture ◽  
Sleep Stages ◽  
Apnea Hypopnea Index ◽  
Rapid Eye Movement ◽  
Sleep Studies ◽  
The Relationship

Introduction: Blood pressure (BP) variability (BPV) is a novel marker for cardiovascular disease (CVD) independent of high BP. Sleep architecture represents the structured pattern of sleep stages consisting of rapid eye movement (REM) and non-rapid eye movement (NREM), and it is an important element in the homeostatic regulation of sleep. Currently, little is known regarding whether BPV is linked to sleep stages. Our study aimed to examine the relationship between sleep architecture and BPV. Methods: We analyzed in-lab polysomnographic studies collected from individuals who underwent diagnostic sleep studies at a university hospital from 2010 to 2017. BP measures obtained during one year prior to the sleep studies were included. BPV was computed using the coefficient of variation for all individuals who had three or more systolic and diastolic BP data. We conducted linear regression analysis to assess the relationship of systolic BPV (SBPV) and diastolic BPV (DBPV) with the sleep stage distribution (REM and NREM sleep time), respectively. Covariates that can potentially confound the relationships were adjusted in the models, including age, sex, race/ethnicity, body mass index, total sleep time, apnea-hypopnea index, mean BP, and history of medication use (antipsychotics, antidepressants, and antihypertensives) during the past two years before the sleep studies. Results: Our sample (N=3,565; male = 1,353) was racially and ethnically diverse, with a mean age 54 ± 15 years and a mean BP of 131/76 ± 13.9/8.4 mmHg. Among the sleep architecture measures examined, SBPV showed an inverse relationship with REM sleep time after controlling for all covariates ( p = .033). We subsequently categorized SBPV into four quartiles and found that the 3 rd quartile (mean SBP SD = 14.9 ± 2.1 mmHg) had 3.3 fewer minutes in REM sleep compared to the 1 st quartile ( p = .02). However, we did not observe any relationship between DBPV and sleep architecture. Conclusion: Greater SBPV was associated with lower REM sleep time. This finding suggests a possible interplay between BPV and sleep architecture. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications.

scholarly journals 1139 Sleep Disturbances In Chronic Stroke Patients: Emotional And Cognitive Impact

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A433-A434
Author(s):  
S N Howell ◽  
S E Robinson ◽  
G S Griesbach
Keyword(s):  
Quality Of Life ◽  
Positive Affect ◽  
Outcome Measures ◽  
Verbal Learning ◽  
Sleep Efficiency ◽  
Cognitive Outcome ◽  
Sleep Stages ◽  
Stroke Patients ◽  
The Impact

Abstract Introduction The objective was to investigate the impact of sleep-wake disturbances (SWD) on cognition and quality of life in the post-acute phase of stroke. Methods Adult stroke (n=92) patients were assessed for SWD via overnight polysomnography. The mean age was 52 ± 1 years and mean latency from injury was 117 ± 10 days. Sleep measures included total sleep time (TST), sleep and REM latency, percent time in sleep stages, apnea/hypopnea index (AHI), wake after sleep onset (WASO), and arousal index. The primary cognitive/outcome measures were: Montreal Cognitive Assessment (MoCA), California Verbal Learning Test (CVLT-II), Neuro-QoL and Mayo Portland Adaptability Inventory (MPAI). Results Women had lower AHI (F(1,88)=9.360, p&lt;.01), fewer arousals (F(1,90)=4.53, p&lt;.05), and spent significantly more time in SWS (F(1,90)=11.525, p&lt;.001) than men; however, SWS was reduced in both sexes. SWS made up &lt; 3% of TST in 60% of patients and was not correlated with higher AHI. SWDs negatively impacted subjective quality of life (NeuroQOL). Longer latencies to sleep were associated with increased depression (p&lt;.05) and decreased positive affect (p&lt;.01). Increased sleep efficiency led to improved positive affect (p&lt;.05) and decreases in emotional/behavioral dyscontrol (p&lt;.05). Increased time in REM sleep decreased emotional/behavioral dyscontrol (p&lt;.05), while increasing satisfaction with social roles and activities(p&lt;.01). SWDs also negatively impacted cognitive/outcome scores. Increased TST and sleep efficiency led to higher scores on CVLT-II list B and long delay free recall (p&lt;.05), while higher AHI led to poorer performance on long delay and forced choice recognition trials (p&lt;.01). Additionally, non-REM AHI negatively impacted MPAI adjustment scores (F(1,69)=4.036, p&lt;.05). Conclusion Male stroke patients displayed significantly more arousals and spent less time in SWS than females. For both sexes, better sleep indicated improved quality of life. Sleep measures were correlated with cognitive/outcome measures. Non-REM AHI significantly predicted outcome at discharge from rehabilitation facility. Support  

Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking

2020 ◽  
Author(s):  
Ayse Didem Esen ◽  
Meltem Akpinar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rem Sleep ◽  
Demographic Data ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference ◽  
Study Population ◽  
The Impact

Abstract Background The data concerning the association of smoking and obstructive sleep apnea (OSA) are limited. The effects of cigarette smoking on OSA still remain obscure. Objectives To reveal the impact of smoking on obstructive sleep apnea. Methods About 384 patients with the diagnosis of OSA through full night polysomnographic (PSG) examination were included to the study. The demographic data (age, sex and BMI), complaints and medical history, status of smoking as non-smokers and smokers, smoking frequency (cigarettes/day), polysomnograhic data comprising apnea hypopnea index (AHI), non-REM sleep AHI (NREM AHI), REM sleep AHI (REM AHI), minimum oxygen saturation (min SaO2) were recorded for all the subjects. Non-smokers and smokers were compared in terms of severity of OSA. Results The study population consisted of 384 subjects, 253 males and 131 females. Smoking frequency was not found correlated with OSA severity. Among smokers, males had higher severe OSA rate (P = 0.002, P &lt; 0.05). In subjects with BMI &lt; 30, severe OSA rate was higher in smokers (34.44% versus 21%) (P = 0.027, P &lt; 0.05). Conclusions Our study detected higher rate of severe OSA in male smokers and smokers with BMI &lt; 30. PSG data did not yield statistically significant difference in non-smokers and smokers. OSA severity was not found correlated with smoking frequency. Along with the study results, the impact of smoking on OSA is still controversial. Prospective studies with larger sample size may be contributive to further evaluation of the association of OSA with smoking.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Betty A McGee ◽  
Melissa Stephenson
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Median Time ◽  
Survival Data ◽  
Stroke Patients ◽  
Eligibility Criteria ◽  
Before And After ◽  
Administration Time ◽  
System Data ◽  
The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Time Of Day ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
The Impact ◽  
Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

Abstract 1122‐000034: Systematic CT‐Perfusion acquisition in All Suspected Stroke Patients Increases Vascular Occlusion Detection and Thrombectomy Rates

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marta Olive‐Gadea ◽  
Manuel Requena ◽  
Facundo Diaz ◽  
Alvaro Garcia‐Tornel ◽  
Marta Rubiera ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Symptoms ◽  
Ct Perfusion ◽  
False Negative ◽  
False Negative Rate ◽  
Vascular Occlusion ◽  
Stroke Patients ◽  
Imaging Protocols ◽  
The Impact

Introduction : In acute ischemic stroke patients, current guidelines recommend noninvasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols on VO diagnosis and EVT rates. Methods : We included patients with a suspected acute ischemic stroke that underwent urgent non‐contrast CT, CTA and CTP from April to October 2020. Hypoperfusion areas defined by Tmax>6s delay (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered due to a VO (CTP‐VO). Cases in which mechanical thrombectomy was performed were defined as therapeutically relevant VO (EVT‐VO). For patients that received EVT, site of VO according to digital subtraction angiography was recorded. Two experienced neuroradiologists blinded to CTP but not to clinical symptoms, retrospectively evaluated NCCT and CTA to identify intracranial VO (CTA‐VO). We analyzed CTA‐VO sensitivity and specificity at detecting CTP‐VO and EVT‐VO respecitvely. We performed a logistic regression to test the association of Tmax>6s volumes with CTA‐VO identification and indication of EVT. Results : Of the 338 patients included in the analysis, 157 (46.5%) presented a CTP‐VO, (median Tmax>6s: 73 [29‐127] ml). CTA‐VO was identified in 83 (24.5%) of the cases. Overall CTA‐VO sensitivity for the detection of CTP‐VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with an increased CTA‐VO detection, with an odds ratio of 1.03 (95% confidence interval 1.02‐1.04) (figure). DSA was indicated in 107 patients; in 4 of them no EVT was attempted due to recanalization or a too distal VO in the first angiographic run. EVT was performed in 103 patients (30.5%. Tmax>6s: 102 [63‐160] ml), representing 65.6% of all CTP‐VO. Overall CTA‐VO sensitivity for the detection of EVT‐VO was 69.9%. The CTA‐VO sensitivity for detecting patients with indication of EVT according to clinical guidelines was as follows: 91.7% for ICA occlusions and 84.4% for M1‐MCA occlusions. For all other occlusion sites that received EVT, the CTA‐VO sensitivity was 36.1%. The overall specificity was 95.3%. Among patients who received EVT, CTA‐VO was not detected in 31 cases, resulting in a false negative rate of 30.1%. False negative CTA‐VO cases had lower Tmax>6s volumes (69[46‐99.5] vs 126[84‐169.5]ml, p<0.001) and lower NIHSS (13[8.5‐16] vs 17[14‐21], p<0.001). Conclusions : Systematically including CTP perfusion in the acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

scholarly journals 1056 REM SLEEP ARCHITECTURE OF STROKE PATIENTS

SLEEP ◽  
2017 ◽  
Vol 40 (suppl_1) ◽  
pp. A392-A393
Author(s):  
S Yepez-Haro ◽  
A Gilles
Keyword(s):  
Rem Sleep ◽  
Sleep Architecture ◽  
Stroke Patients

scholarly journals Triglyceride glucose index influences platelet reactivity in acute ischemic stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yinping Guo ◽  
Jing Zhao ◽  
Yi Zhang ◽  
Lingshan Wu ◽  
Zhiyuan Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Platelet Reactivity ◽  
Multivariate Logistic Regression Analysis ◽  
Platelet Inhibition ◽  
Inhibition Rate ◽  
Stroke Patients ◽  
Tyg Index ◽  
Significant Difference

Abstract Aim Insulin resistance was reported to increase the risk of ischemic stroke, which can be assessed by the triglyceride glucose (TyG) index. However, it remains unclear whether the TyG index influences the platelet reactivity during the treatment of ischemic patients. Methods Ischemic stroke patients receiving dual antiplatelet therapy (DAPT) within 48 h onset were consecutively included. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The top quartile of TyG index was defined as insulin resistance. The platelet reactivity was assessed by thromboelastography. The platelet inhibition rate induced by arachidonic acid (AA) or adenosine diphosphate (ADP) was used to confirm the high residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel, respectively. The association between TyG index and platelet reactivity was assessed by Kruskal–Wallis test. The independent risk factors of HRPR were determined by multivariate logistic regression analysis. Results A total of 1002 patients were included and divided into 4 groups by quartiles of the TyG index (< 2.02; 2.02–2.27; 2.27–2.52; ≥2.52). The findings demonstrated that the maximum intensity of the clot increased, but the AA-induced platelet inhibition rate decreased, depending on the TyG index quartiles. No significant difference was found in the ADP-induced platelet inhibition rate among groups. The prevalence of aspirin HRPR increased depending on the TyG index quartile. Unlike the non-insulin resistance group, the insulin resistance group was independently associated with aspirin HRPR (OR = 1.689, 95% CI 1.14 to 2.51, P = 0.009). Conclusions In acute ischemic stroke patients taking DAPT, the elevation of the TyG index is associated with enhanced platelet reactivity and higher prevalence of aspirin HRPR. Insulin resistance assessed by the TyG index could be an independent risk factor for aspirin HRPR.

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