István Szegedi1, Rita Orbán-Kálmándi2, Attila Nagy3, Ferenc Sarkady2, Nikolett Vasas4, Máté Sik4, Levente István Lánczi4, Ervin Berényi4, László Oláh1, Alexandra Crișan5, László Csiba1,6, Zsuzsa Bagoly2,6. 1. Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, Debrecen, Hungary. 2. Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. 3. Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary. 4. Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. 5. Department of Neurology, City Hospital of Odorheiu-Secuiesc, Odorheiu Secuiesc, Romania. 6. ELKH-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary.
Abstract
BACKGROUND: Intravenous thrombolysis using recombinant tissue plasminogen activator remains the mainstay treatment of acute ischemic stroke (AIS), although endovascular treatment is becoming standard of care in case of large vessel occlusions (LVO). To quantify the thrombus burden in LVO, a semiquantitative CT angiography (CTA) grading system, the clot burden score (CBS) can be used. Here we aimed to study the association between CBS and various hemostasis parameters, and to evaluate which parameters are major determinants of thrombolysis outcome. METHODS: In this single-centered prospective observational case-control study, 200 anterior circulation AIS patients receiving intravenous thrombolysis treatment without thrombectomy were enrolled: 100 AIS patients with LVO (CBS 0-9) and 100 age- and sex-matched AIS patients without LVO (CBS 10). Fibrinogen, α2-plasmin inhibitor, plasminogen, factor XIII and D-dimer were assessed from blood samples taken before and 24 h after thrombolysis, and FXIII-A Val34Leu was genotyped. CBS was calculated using admission CTA. Short-term outcomes were defined based on the change in NIHSS by day 7, long-term outcomes were assessed according to the modified Rankin scale at 3 months post-event. RESULTS: Poor outcomes were significantly more frequent in the CBS 0-9 group. Plasminogen activity on admission was significantly higher in the CBS 0-9 group. In a univariate analysis, significant protective effect of the Leu34 allele against developing larger clots (CBS 0-9) could be demonstrated (OR:0.519; 95%CI:0.298-0.922, p = 0.0227). Multivariate regression analysis revealed that CBS is an independent predictor of short- and long-term functional outcomes, while such effect of the studied hemostasis parameters could not be demonstrated. CONCLUSIONS: CBS was found to be a significant independent predictor of thrombolysis outcomes. FXIII-A Leu34 carrier status was associated with smaller thrombus burden, which is consistent with the in vitro described whole blood clot mass reducing effects of the allele, but the polymorphism had no effect on thrombolysis outcomes.
BACKGROUND: Intravenous thrombolysis using recombinant tissue plasminogen activator remains the mainstay treatment of acute ischemic stroke (AIS), although endovascular treatment is becoming standard of care in case of large vessel occlusions (LVO). To quantify the thrombus burden in LVO, a semiquantitative CT angiography (CTA) grading system, the clot burden score (CBS) can be used. Here we aimed to study the association between CBS and various hemostasis parameters, and to evaluate which parameters are major determinants of thrombolysis outcome. METHODS: In this single-centered prospective observational case-control study, 200 anterior circulation AISpatients receiving intravenous thrombolysis treatment without thrombectomy were enrolled: 100 AISpatients with LVO (CBS 0-9) and 100 age- and sex-matched AISpatients without LVO (CBS 10). Fibrinogen, α2-plasmin inhibitor, plasminogen, factor XIII and D-dimer were assessed from blood samples taken before and 24 h after thrombolysis, and FXIII-A Val34Leu was genotyped. CBS was calculated using admission CTA. Short-term outcomes were defined based on the change in NIHSS by day 7, long-term outcomes were assessed according to the modified Rankin scale at 3 months post-event. RESULTS: Poor outcomes were significantly more frequent in the CBS 0-9 group. Plasminogen activity on admission was significantly higher in the CBS 0-9 group. In a univariate analysis, significant protective effect of the Leu34 allele against developing larger clots (CBS 0-9) could be demonstrated (OR:0.519; 95%CI:0.298-0.922, p = 0.0227). Multivariate regression analysis revealed that CBS is an independent predictor of short- and long-term functional outcomes, while such effect of the studied hemostasis parameters could not be demonstrated. CONCLUSIONS: CBS was found to be a significant independent predictor of thrombolysis outcomes. FXIII-A Leu34 carrier status was associated with smaller thrombus burden, which is consistent with the in vitro described whole blood clot mass reducing effects of the allele, but the polymorphism had no effect on thrombolysis outcomes.
Authors: Edina Gabriella Székely; Rita Orbán-Kálmándi; István Szegedi; Éva Katona; Barbara Baráth; Katalin Réka Czuriga-Kovács; Linda Lóczi; Nikolett Vasas; István Fekete; Klára Fekete; Ervin Berényi; László Oláh; László Csiba; Zsuzsa Bagoly Journal: Front Cardiovasc Med Date: 2022-07-15