Abstract Number: OC 02.5
Meeting: ISTH 2020 Congress
Background: Intravenous thrombolysis by recombinant tissue plasminogen activator (rt-PA) fails to achieve recanalization in a large subset of acute ischemic stroke (AIS) patients, while in approximately 6-8% of cases intracerebral hemorrhage (ICH) occurs.
Aims: Here we aimed to investigate α2-plasmin inhibitor (α2-PI) levels during thrombolysis and to find out whether they predict therapy outcomes in AIS patients.
Methods: In this prospective, observational study, blood samples of 418 AIS patients, all undergoing intravenous thrombolysis by rtPA within 4.5h of their symptom onset, were taken before and 24h after thrombolysis. In a subset of patients (n=131), blood was also obtained immediately post-lysis. α2-PI activity and antigen levels were measured by chromogenic assay and an in-house ELISA detecting all forms of α2-PI, respectively. Stroke severity was determined by NIHSS on admission, day 1 and 7. Therapy-associated ICH was classified according to ECASSII. Long-term outcomes were defined at 3 months post-event by the modified Rankin Scale (mRS). All patients or relatives provided informed consent.
Results: Median α2-PI activity and antigen levels showed a significant drop immediately post-lysis and increased to subnormal levels at 24h post-event. α2-PI levels on admission showed a significant negative step-wise association with stroke severity. Patients with favorable long-term outcomes (mRS 0-1) had significantly higher on admission α2-PI antigen levels (median:61.4 [IQR:55.5-70.5] mg/L) as compared to patients with poor outcomes (mRS 2-5: median:58.9 [IQR:52.8-66.7] and mRS 6: median:56.4 [IQR:50.9-61.0] mg/L, p=0.009). A multiple logistic regression model revealed that an α2-PI antigen level in the lower quartile before thrombolysis is an independent predictor of poor outcome (mRS>2) at 3 months after the event (OR:1.72; 95%CI:1.02-2.95, p=0.044). In patients with therapy-related ICH (n=32), admission α2-PI antigen levels were significantly lower as compared to those without hemorrhagic complications.
Conclusions: A low α2-PI antigen level on admission is an independent predictor of unfavorable long-term outcomes in AIS patients undergoing thrombolysis.
To cite this abstract in AMA style:Orbán-Kálmándi R, Baráth B, Sarkady F, Székely E, Szegedi I, Czuriga-Kovács KR, Fekete I, Fekete K, Katona É, Csiba L, Bagoly Z. Low α2-plasmin Inhibitor Antigen Levels on Admission Predict Unfavorable Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/low-%ce%b12-plasmin-inhibitor-antigen-levels-on-admission-predict-unfavorable-outcomes-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis/. Accessed March 3, 2021.
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