title: Plasma ADAMTS13 activity and von Willebrand factor antigen and activity in patients with subarachnoid haemorrhage.
abstract: Increased von Willebrand factor (VWF) and reduced ADAMTS13 activity are associated with arterial thrombosis. This may also be the culprit mechanism implicated in delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). It was our objective to determine plasma VWF and ADAMTS13 in patients with SAH and healthy subjects; and to explore the levels of those markers and outcome after SAH. Forty consecutive patients were enrolled between September 2007 and April 2014 in a pilot study. Plasma samples were collected from SAH patients on post-bleed day (PBD) 0, 1, 3, 5, 7 and 10 and healthy controls. VWF antigen (VWFAg) and VWF activity (VWFAc) were determined by enzyme-linked immunoassay and collagen binding assay, respectively. ADAMTS13 activity was determined by the cleavage of a fluorescent substrate. Univariate descriptive statistics and cluster analyses were performed based on outcomes in the group with SAH only. Mean age of SAH patients was 52.4 years (26-84 years) and 30 (75 %) were women. 12/40 (30 %) had a high Hunt and Hess grade (IV-V) and 25 (62.5 %) were treated with coil embolisation. Plasma VWFAg and VWFAc were significantly higher in SAH patients than those in healthy subjects on each PBD (p<0.0001). Concurrently, plasma ADAMTS13 activity in SAH patients was significantly lower than that in healthy subjects (p<0.0001). Among those with SAH, cluster analysis demonstrated that patients with higher VWFAg and VWFAc and/or lower ADAMTS13 activity might be at risk of increased mortality. In conclusion, the relative deficiency of plasma ADAMTS13 activity in SAH patients may associate with worse outcome.
authors.forename: Monisha
authors.initials: M
authors.lastname: Kumar
authors.forename: Wenjing
authors.initials: W
authors.lastname: Cao
authors.forename: Jenny K
authors.initials: JK
authors.lastname: McDaniel
authors.forename: Huy P
authors.initials: HP
authors.lastname: Pham
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Raju
authors.forename: Kelsey
authors.initials: K
authors.lastname: Nawalinski
authors.forename: Suzanne
authors.initials: S
authors.lastname: Frangos
authors.forename: David
authors.initials: D
authors.lastname: Kung
authors.forename: Eric
authors.initials: E
authors.lastname: Zager
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levine
authors.affiliation: X. Long Zheng, MD, PhD, Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA, E-mail: xzheng@uabmc.edu.
authors.forename: X Long
authors.initials: XL
authors.lastname: Zheng
mesh_terms: D000071120:ADAMTS13 Protein / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D016022:Case-Control Studies; D016000:Cluster Analysis; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000201:enzymology / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human
keywords: ADAMTS13; Subarachnoid haemorrhage; and brain aneurysm; delayed cerebral ischaemia; microvascular thrombosis; platelet hypercoagulability; von Willebrand factor