Hemostatic Activation and Outcome After Recombinant Tissue Plasminogen Activator Therapy for Acute Ischemic Stroke
- 1 July 2006
- journal article
- research article
- Published by Wolters Kluwer Health in Stroke
- Vol. 37 (7), 1798-1804
- https://doi.org/10.1161/01.str.0000226897.43749.27
Abstract
Background and Purpose— Early thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rtPA) improves clinical outcome in acute ischemic stroke (AIS), but impaired endogenous fibrinolysis, thrombin generation, and vascular injury may hamper the efficacy of thrombolysis. We investigated in an exploratory, post hoc analysis the relationship between hemostatic markers and clinical outcomes among patients included in the National Institute of Neurological Disorders and Stroke (NINDS) rtPA Stroke Study. Methods— Tissue plasminogen activator (tPA) antigen, thrombin-antithrombin complex (TAT), soluble thrombomodulin, and fibrinogen levels were measured in patients with AIS included in the NINDS rtPA Stroke Study from plasma samples collected at baseline, at 2 hours after treatment, and after 24 hours. Results— TAT and tPA antigen levels peaked at 2 hours selectively in the rtPA treatment group, whereas fibrinogen levels dropped at 2 hours and remained low after 24 hours ( P Conclusions— Hemostatic activation after AIS appears to be independently associated with clinical outcome in patients treated with rtPA. However, because we have tested for multiple associations, some may have been identified by chance alone and require further confirmatory studies. On the basis of this exploratory analysis, there is a rationale to investigate the safety and efficacy of protocols in which rtPA is complemented by agents that are antithrombotic and enhance fibrinolysis.Keywords
This publication has 17 references indexed in Scilit:
- Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PANeurology, 2005
- Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcomeEuropean Heart Journal, 2005
- Soluble Thrombomodulin and Brain InfarctionStroke, 2004
- Acute Release of Plasminogen Activator Inhibitor-1 in ST-Segment Elevation Myocardial Infarction Predicts MortalityCirculation, 2003
- Adding to the Effectiveness of Intravenous Tissue Plasminogen Activator for Treating Acute StrokeCirculation, 2003
- Usefulness of fibrinogenolytic and procoagulant markers during thrombolytic therapy in predicting clinical outcomes in acute myocardial infarctionThe American Journal of Cardiology, 1996
- Tissue Plasminogen Activator for Acute Ischemic StrokeNew England Journal of Medicine, 1995
- Prospective study of endogenous tissue plasminogen activator and risk of strokeThe Lancet, 1994
- Activation of prothrombin accompanying thrombolysis with recombinant tissue-type plasminogen activatorJournal of the American College of Cardiology, 1992
- Analysis of data from multiclinic trialsControlled Clinical Trials, 1986