This Article Full Text Full Text (PDF) All Versions of this Article: 35/6/1280    most recent 01.STR.0000128707.48644.7ev1 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 Vergouwen, M.D.I. Articles by Vermeulen, M. Search for Related Content PubMed PubMed Citation Articles by Vergouwen, M.D.I. Articles by Vermeulen, M. Related Collections Coagulation and fibronolysis Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage

(Stroke. 2004;35:1280.)
© 2004 American Heart Association, Inc.

Original Contributions

Plasminogen Activator Inhibitor-1 4G Allele in the 4G/5G Promoter Polymorphism Increases the Occurrence of Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

M.D.I. Vergouwen, MD; C.J.M. Frijns, MD, PhD; Y.B.W.E.M. Roos, MD, PhD; G.J.E. Rinkel, MD, FAHA; F. Baas, MD, PhD M. Vermeulen, MD, PhD

From the Department of Neurology (M.D.I.V., Y.B.W.E.M.R., F.B., M.V.), Academic Medical Centre, University of Amsterdam, The Netherlands; and Department of Neurology (C.J.M.F., G.J.E.R.), University Medical Centre Utrecht, The Netherlands.

Correspondence to Dr M.D.I. Vergouwen, Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail m.d.vergouwen{at}amc.uva.nl

Background and Purpose— In several acute life-threatening diseases, the 4G-allele in the 4G/5G-promotor polymorphism in the plasminogen activator inhibitor-1 (PAI-1) gene is associated with higher PAI-1 levels and increased poor outcome, probably by promoting the formation of microthrombi. The aim of the present study was to investigate whether the PAI-1 4G/5G polymorphism is associated with the occurrence of cerebral ischemia, rebleeding, and other events, and clinical outcome after aneurysmal subarachnoid hemorrhage.

Methods— DNA was collected and analyzed in 126 patients with aneurysmal subarachnoid hemorrhage admitted to the Academic Medical Centre Amsterdam and University Medical Centre Utrecht in the Netherlands. All episodes of deterioration were classified according to predefined criteria. Causes of poor outcome and functional outcome were assessed 3 months after the initial bleeding according to the 5-point Glasgow Outcome Scale (GOS).

Results— Secondary ischemia occurred more often in patients with the 4G genotype than in patients homozygous for the 5G allele (RR: 3.3; 95% CI: 1.1 to 10.0). No significant differences were found between the groups for rebleeding or other events. Patients with the 4G genotype tended to have a higher risk for poor outcome than patients with the 5G/5G genotype (RR 1.2; 95% CI 0.7 to 2.2).

Conclusion— The 4G allele in the PAI-1 gene increases the risk for cerebral ischemia after aneurysmal subarachnoid hemorrhage (SAH) and probably also the risk for poor outcome. After early aneurysm occlusion, treatment aimed at enhancing fibrinolysis might be effective to prevent and treat cerebral ischemia in patients with aneurysmal SAH.

Key Words: plasminogen activator inhibitor-1 • subarachnoid hemorrhage • cerebral ischemia

This article has been cited by other articles:

				A. Deng, C. D. Gocke, J. Hess, M. Heyman, M. Paltiel, and A. Gaspari Livedoid Vasculopathy Associated With Plasminogen Activator Inhibitor-1 Promoter Homozygosity (4G/4G) Treated Successfully With Tissue Plasminogen Activator. Arch Dermatol, November 1, 2006; 142(11): 1466 - 1469. [Abstract] [Full Text] [PDF]