Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

Bagoly, Zsuzsa; Szegedi, István; Kálmándi, Rita; Tóth, Noémi; Csiba, László

doi:10.3389/fneur.2019.00513

Cited by 50 publications

(50 citation statements)

References 83 publications

(117 reference statements)

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“…Studies showed that a decrement in 2 hours postthrombolysis fibrinogen levels to less than 2 g/L increased the odds of an early sICH by 12.82 times. 24 Our study also demonstrated that the serum fibrinogen levels fell significantly after thrombolysis, the mean fibrinogen decreasing by 7% (p < 0.0001) and we recorded an sICH rate of 13.33%. The Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis study also demonstrated that alteplase was associated with prolongation of prothrombin time, reduction of plasminogen and fibrinogen levels, and elevation of FDP and D-dimer levels.…”

Section: Discussion On Fibrinogen As a Biomarkersupporting

confidence: 77%

“…Bagoly et al's review article demonstrated that the assessment of pre-and postthrombolysis plasma fibrinogen levels was potentially useful to predict postthrombolysis sICH but more data are needed to establish its association with unfavorable outcome. 24 The study was limited by small sample size, suffers from the probability of selection bias for not including a control group consisting of patients not receiving thrombolytic treatment, our inability to estimate FDP levels in all patients, lack of a long-term follow-up, and lack of MRIbased protocols prior to thrombolysis, thereby, hindering our ability to test leukoaraiosis, microbleeds, and low ADC coefficient as predictors of sICH. Therefore, the results should be confirmed in multicenter cohort studies.…”

Section: Discussion On Fibrinogen As a Biomarkermentioning

confidence: 99%

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Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Das

Mondal

Bhattacharya

et al. 2020

JNRP

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Background Thrombolysis improves the outcome in acute ischemic stroke (AIS), albeit with an increased risk of symptomatic intracranial hemorrhage (sICH). Biomarkers to find patients at risk of sICH, and guide treatment and prognosis would be valuable. Methods Consecutive patients of AIS thrombolysed between February 2017 and September 2019 at Calcutta National Medical College were studied prospectively for sICH and outcome at 6-month follow-up. We identified the independent risk factors for unfavorable outcomes, mortality, and sICH using multivariate analysis. Prethrombolysis and 24-hour postthrombolysis fibrinogen levels were estimated to evaluate its biomarker role. Results Out of 180 AIS patients admitted during the study period, 60 patients were thrombolysed. Door to needle time was <3 hours among 24 patients and 3 to 4.5 hours among 36 patients. Favorable outcomes occurred among 76.67% and sICH occurred among 13.33% patients. Upper tertile of National Institute of Health Stroke Scale (NIHSS) had the highest adjusted odds for sICH (17.5 [95% confidence intervals=1.7–178.44]). Total anterior circulation stroke had the highest adjusted odds for unfavorable outcome (19.11 [3.9–92.6]). Following thrombolysis, the mean (standard deviation) fibrinogen level of 449.27 (32.87) decreased 7% to postthrombolysis level of 420 (20.5; p< 0.0001). Higher tertiles of fibrinogen levels had progressively increasing odds for morbidity and sICH. Conclusion Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke (double weight), i.e., CHADS2 score >2, low ejection fraction, the occurrence of total anterior circulation stroke and higher mean arterial blood pressure, blood glucose level, NIHSS score, and fibrinogen at admission were the common risk factors significantly predicting postthrombolysis sICH and morbidity. Antiplatelet and anticoagulant therapy, lower ASPECT (Alberta Stroke Program Early CT Score), and higher SEDAN scores also predicted sICH . Fibrinogen levels were significantly higher among those developing sICH and having unfavorable outcome. The performance of thrombolysis within 3 hours or between 3 and 4.5 hours after symptom onset did not affect morbidity, mortality, or the occurrence of sICH.

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Section: Discussion On Fibrinogen As a Biomarkersupporting

confidence: 77%

Section: Discussion On Fibrinogen As a Biomarkermentioning

confidence: 99%

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Das

Mondal

Bhattacharya

et al. 2020

JNRP

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“…The non-TIA <24-hour ischemic stroke group analyzed in this study was older (68.08 ± 14.47) than patients reported in other studies (mean age of 63) [1]. Moreover, the TIA-24hr-ischemic stroke population in this study consists of a significant proportion of patients > 80 years, not excluded from rtPA in line with AHA guidelines [24] and reported to be safe by several studies [25][26][27]. The prevalence of a prior TIA in patients with ischemic stroke in the general population is between 7% to 40% [13,28,29].…”

Section: Discussionmentioning

confidence: 57%

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Poupore

Strat

Mackey

et al. 2019

Preprint

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Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

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“…The past-TIA ischemic stroke group analyzed in this study was older (68.08 ± 14.47) than patients reported in other studies (mean age of 63) [1]. Moreover, the recent-TIA ischemic stroke population in this study consists of a significant proportion of patients > 80 years, not excluded from rtPA in line with AHA guidelines [24] and reported to be safe by several studies [25][26][27]. The prevalence of a prior TIA in patients with ischemic stroke in the general population is between 7 to 40% [13,28,29].…”

Section: Discussionmentioning

confidence: 69%

Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy

et al. 2020

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Background: Acute ischemic stroke attack with and without a recent TIA may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 h preceding ischemic stroke (recent-TIA) as compared to those without recent TIA or non-TIA > 24 h and less than 1 month (past-TIA). Methods: A retrospective hospital-based analysis was conducted on 6315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 h prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model. Results: In the recent-TIA ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR = 4.277, 95% CI, 1.095-16.703, p = 0.037), and increasing NIHSS score (OR = 1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934-0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA. Conclusion: In recent-TIA ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in recent-TIA ischemic stroke patients.

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Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

Cited by 50 publications

References 83 publications

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy

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