Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA.
OBJECTIVE
To determine whether pretreatment markers of coagulation and fibrinolysis are related to recanalization and functional outcome.


METHODS
The authors included patients treated with IV rt-PA with occlusion on baseline transcranial Doppler (Thrombolysis in Brain Ischemia [TIBI] criteria) in whom recanalization within 6 hours was monitored. At baseline, the authors recorded data about demographics, vascular risk factors, the NIH Stroke Scale (NIHSS) score, early CT signs, etiology, blood glucose, and time to rt-PA. The authors also measured plasmatic markers of coagulation (fibrinogen, prothrombin fragments 1 + 2, Factor XIII, Factor VII) and fibrinolysis (alpha2-antiplasmin, Plasminogen Activator Inhibitor, Functional Thrombin Activatable Fibrinolysis Inhibitor [fTAFI]). A favorable outcome was defined as a modified Rankin score < 2 at 3 months.


RESULTS
The authors studied 63 patients with a mean age of 67.3 +/- 12.5 years. The median NIHSS score was 16. Patients who recanalized had lower concentrations of alpha2-antiplasmin (87.5 +/- 18% vs 96.5 +/- 12.5%, p = 0.023) and fTAFI (91.7 +/- 26.7% vs 104.4 +/- 21%, p = 0.039). A multivariant logistic regression analysis showed that the level of alpha2-antiplasmin was the only predictive variable of recanalization (OR 0.95, 95% CI 0.91, 0.99, p = 0.038), while the NIHSS score was the only predictive variable of functional outcome (OR 0.81, 95% CI 0.72, 0.92, p = 0.001).


CONCLUSIONS
Baseline levels of alpha2-antiplasmin were predictive of recanalization but were not related to the long-term outcome in patients treated with rt-PA within the first 3 hours.
Martí-Fàbregas
J
J
Departments of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jmarti@hsp.santpau.es
Borrell
M
M
Cocho
D
D
Belvís
R
R
Castellanos
M
M
Montaner
J
J
Pagonabarraga
J
J
Aleu
A
A
Molina-Porcel
L
L
Díaz-Manera
J
J
Bravo
Y
Y
Alvarez-Sabín
J
J
Dávalos
A
A
Fontcuberta
J
J
Martí-Vilalta
J-L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects / Q000502:physiology; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D015415:Biomarkers; D005343:Fibrinolytic Agents; D011993:Recombinant Fusion Proteins; D000979:alpha-2-Antiplasmin; D010959:Tissue Plasminogen Activator