This Article Full Text Full Text (PDF) All Versions of this Article: 35/9/2123    most recent 01.STR.0000137608.73660.4cv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ribo, M. Articles by Alvarez-Sabín, J. Search for Related Content PubMed PubMed Citation Articles by Ribo, M. Articles by Alvarez-Sabín, J. Related Collections Thrombolysis Acute Cerebral Infarction Brain Circulation and Metabolism Emergency treatment of Stroke Fibrinolysis

(Stroke. 2004;35:2123.)
© 2004 American Heart Association, Inc.

Original Contributions

Admission Fibrinolytic Profile Is Associated With Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Tissue Plasminogen Activator

Marc Ribo, MD; Joan Montaner, MD, PhD; Carlos A. Molina, MD, PhD; Juan F. Arenillas, MD, PhD; Esteban Santamarina, MD; Manuel Quintana José Alvarez-Sabín, MD, PhD

From the Neurovascular Research Laboratory, Neurovascular Unit Hospital Vall d’Hebron, Barcelona, Spain, and the Universitat Autonoma de Barcelona, Spain.

Correspondence to Dr Marc Ribo, Unitat Neurovascular, Servei de Neurologia (9^a planta Hospital General), Hospital Vall d’Hebron, Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail marcriboj{at}hotmail.com

Background and Purpose— Symptomatic intracranial hemorrhage (SICH) is the most feared complication after tissue plasminogen activator (tPA) stroke treatment. Endogenous fibrinolysis inhibitors play an essential role in the coagulation/fibrinolysis balance and may be involved in the bleeding process. We aim to determine the predictive value of pretreatment levels of fibrinolysis inhibitors (PAI-1, lipoprotein(a), TAFI, and homocysteine) on SICH.

Methods— Consecutive tPA-treated stroke patients with middle cerebral artery occlusion were studied. Baseline blood samples were obtained just before tPA administration and fibrinolysis inhibitors were determined. A second computed tomography (CT) scan was obtained at 24 hours or when a neurological worsening occurred to rule out SICH.

Results— Seventy-seven patients (40% women, age 75 years) were studied. Median admission National Institutes of Health Stroke Scale was 17 (range, 7 to 22) and mean time to treatment was 160 minutes. Six patients (7.9%) presented with a SICH. In analyses based on clinical and CT variables, no relation could be found with SICH. When laboratory data were analyzed, patients who experienced SICH showed lower baseline PAI-1 (21.7±3.5 ng/mL versus 31.8±12.1 ng/mL; P<0.01) and higher TAFI (216.7±78.4% versus 162.1±54.2%; P=0.03). Homocysteine and lipoprotein(a) were not related to SICH. The only factors associated with SICH were TAFI >180% (OR, 12.9; CI, 1.41 to 118.8; P=0.02) and PAI-1 <21.4 ng/mL (OR, 12.75; CI, 1.17 to 139.2; P=0.04). The combination of admission PAI-1 <21.4 ng/mL and TAFI >180% had a sensibility of 75% and a specificity of 97.6% (P<0.01) predicting SICH, with a positive predictive value of 75% and negative predictive value of 97.6%.

Conclusions— Baseline PAI-1 and TAFI levels predict SICH after stroke tPA therapy. In the future, these biomarkers could be used to improve thrombolysis safety.

Key Words: blood–brain barrier • complications • hemostasis • stroke, acute • thrombolysis

This article has been cited by other articles:

				M. G. Lansberg, V. N. Thijs, R. Bammer, S. Kemp, C. A.C. Wijman, M. P. Marks, G. W. Albers, and on behalf of the DEFUSE Investigators Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke Stroke, August 1, 2007; 38(8): 2275 - 2278. [Abstract] [Full Text] [PDF]

				P. Khatri, L. R. Wechsler, and J. P. Broderick Intracranial Hemorrhage Associated With Revascularization Therapies Stroke, February 1, 2007; 38(2): 431 - 440. [Abstract] [Full Text] [PDF]

				M. Rodriguez-Yanez, M. Castellanos, M. Blanco, M. Millan, F. Nombela, T. Sobrino, I. Lizasoain, R. Leira, J. Serena, A. Davalos, et al. Micro- and macroalbuminuria predict hemorrhagic transformation in acute ischemic stroke. Neurology, October 10, 2006; 67(7): 1172 - 1177. [Abstract] [Full Text] [PDF]

				D. Cocho, M. Borrell, J. Marti-Fabregas, J. Montaner, M. Castellanos, Y. Bravo, L. Molina-Porcel, R. Belvis, J.-A. Diaz-Manera, A. Martinez-Domeno, et al. Pretreatment Hemostatic Markers of Symptomatic Intracerebral Hemorrhage in Patients Treated With Tissue Plasminogen Activator Stroke, April 1, 2006; 37(4): 996 - 999. [Abstract] [Full Text] [PDF]