title: Lower concentrations of thrombin-antithrombin complex (TAT) correlate to higher recanalisation rates among ischaemic stroke patients treated with t-PA.
abstract: An elevated concentration of the thrombin-antithrombin complex (TAT) has been associated with high mortality rates and poor outcome in ischaemic stroke patients treated with tissue plasminogen activator (t-PA). Moreover, antithrombin drugs have been tested in combination with t-PA in the acute phase of ischaemic stroke to increase treatment efficacy. We aimed to study whether poor outcome associated with TAT among ischaemic stroke patients treated with t-PA could be due to the effects of this complex on recanalisation rates of the middle cerebral artery (MCA) and on haemorrhagic transformation. The TAT levels of 89 patients having a proximal MCA occlusion were measured by ELISA, and the patients were then treated with t-PA. Complete recanalisation was diagnosed by transcranial Doppler (TCD) at 1, 2 and 6 hours post-t-PA infusion and haemorrhagic transformation was identified by computed tomography (CT). Lower levels of TAT were associated with better recanalisation rates at all time-points (1 hour: OR = 24.8 95% CI 1.4-434.8, p = 0.028; 2 hours: OR = 6.3 95% CI 1.5-27, p = 0.014; 6 hours: OR = 6.4 95% CI 1.5-26.5, p = 0.011) after adjustment for stroke risk factors. However, no correlation was found between TAT concentration and haemorrhagic transformation. The elevated mortality rates previously observed in patients with high levels of TAT might have been due to revascularisation resistance. Low levels of TAT are not associated with an increase in haemorrhagic complications after t-PA, indicating that the combination of thrombin blockers and t-PA could be a safe and effective treatment for ischaemic stroke in the future.
authors.affiliation: Neurovascular Research Laboratory, Neurovascular Unit. Neurology Service, Departamento de medicina, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Fernandez-Cadenas
authors.forename: Maite
authors.initials: M
authors.lastname: Mendioroz
authors.forename: Josep
authors.initials: J
authors.lastname: Munuera
authors.forename: José
authors.initials: J
authors.lastname: Alvarez-Sabin
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.forename: Adoracion
authors.initials: A
authors.lastname: Quiroga
authors.forename: Natalia
authors.initials: N
authors.lastname: Corbeto
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.forename: Pilar
authors.initials: P
authors.lastname: Delgado
authors.forename: Anna
authors.initials: A
authors.lastname: Rosell
authors.forename: Marc
authors.initials: M
authors.lastname: Ribó
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Molina
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D015415:Biomarkers / Q000378:metabolism*; D002545:Brain Ischemia / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood*; D011379:Prognosis; D011485:Protein Binding; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D013917:Thrombin / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D013917:Thrombin; D010959:Tissue Plasminogen Activator