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NEUROLOGY 2005;65:366-370
© 2005 American Academy of Neurology

Hemostatic markers of recanalization in patients with ischemic stroke treated with rt-PA

J. Martí-Fàbregas, MD, PhD, M. Borrell, PhD, D. Cocho, MD, R. Belvís, MD, M. Castellanos, MD, PhD, J. Montaner, MD, PhD, J. Pagonabarraga, MD, A. Aleu, MD, L. Molina-Porcel, MD, J. Díaz-Manera, MD, Y. Bravo, MD, J. Alvarez-Sabín, MD, PhD, A. Dávalos, MD, PhD, J. Fontcuberta, MD, PhD and J. -L. Martí-Vilalta, MD, PhD

From the Departments of Neurology (Drs. Martí-Fàbregas, Cocho, Belvís, Pagonabarraga, Aleu, Molina-Porcel, Díaz-Manera, Bravo, and Martí-Vilalta) and Hematology (Drs. Borrell and Fontcuberta), Hospital de la Santa Creu i Sant Pau, Barcelona; the Department of Neurology (Dr. Castellanos), Hospital Dr. Josep Trueta, Girona; the Department of Neurology (Dr. Dávalos), Hospital Universitari Germans Trias i Pujol, Badalona; and the Department of Neurology (Drs. Montaner and Alvarez-Sabín), Hospital de la Vall d’Hebron, Barcelona, Spain.

Address correspondence and reprint requests to Dr. Joan Martí-Fàbregas, Servei de Neurologia, Hospital de la Santa Creu i Sant Pau, Avda Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain; e-mail: jmarti{at}hsp.santpau.es

Objective: To determine whether pretreatment markers of coagulation and fibrinolysis are related to recanalization and functional outcome.

Methods: The authors included patients treated with IV rt-PA with occlusion on baseline transcranial Doppler (Thrombolysis in Brain Ischemia [TIBI] criteria) in whom recanalization within 6 hours was monitored. At baseline, the authors recorded data about demographics, vascular risk factors, the NIH Stroke Scale (NIHSS) score, early CT signs, etiology, blood glucose, and time to rt-PA. The authors also measured plasmatic markers of coagulation (fibrinogen, prothrombin fragments 1 + 2, Factor XIII, Factor VII) and fibrinolysis ({alpha}2-antiplasmin, Plasminogen Activator Inhibitor, Functional Thrombin Activatable Fibrinolysis Inhibitor [fTAFI]). A favorable outcome was defined as a modified Rankin score < 2 at 3 months.

Results: The authors studied 63 patients with a mean age of 67.3 ± 12.5 years. The median NIHSS score was 16. Patients who recanalized had lower concentrations of {alpha}2-antiplasmin (87.5 ± 18% vs 96.5 ± 12.5%, p = 0.023) and fTAFI (91.7 ± 26.7% vs 104.4 ± 21%, p = 0.039). A multivariant logistic regression analysis showed that the level of {alpha}2-antiplasmin was the only predictive variable of recanalization (OR 0.95, 95% CI 0.91, 0.99, p = 0.038), while the NIHSS score was the only predictive variable of functional outcome (OR 0.81, 95% CI 0.72, 0.92, p = 0.001).

Conclusion: Baseline levels of {alpha}2-antiplasmin were predictive of recanalization but were not related to the long-term outcome in patients treated with rt-PA within the first 3 hours.

Supported in part by a grant from the Societat Catalana de Neurologia.

Disclosure: The authors report no conflicts of interest.

Received December 21, 2004. Accepted in final form April 19, 2005.


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