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Post-thrombolysis haemostasis changes after rt-PA treatment in acute cerebral infarct. Correlations with cardioembolic aetiology and outcome
- Source :
- Journal of the Neurological Sciences. 349:77-83
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- Little is known, in man, in the post-thrombolytic molecular dynamics of haemostasis, particularly the effect of rt-PA on antifibrinolytic components such as alpha2 anti-plasmin and Factor XIII.The purpose of this study was to systematically determine changes in coagulation and fibrinolytic parameters after thrombolysis with rt-PA during 24h. We also aimed to correlate these parameters with different acute ischemic stroke subtypes and global outcome.Eighty consecutive patients with cerebral infarcts treated with rt-PA had their plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, Factor XIII, fibrin(ogen) degradation products (FDP) and D-Dimers measured at baseline (h0), 2 (h2) and 24h (h24) after initiation of thrombolysis. Correlations between the variations of these components were statistically studied, using the Spearman rank test or the Pearson test. These haemostatic parameters were also compared with cardioembolic and non cardioembolic patients, as well as between poor and favourable outcome patients.Between h0 and h2, a decrease in fibrinogen, plasminogen, alpha2-antiplasmin, and factor XIII was observed, while an increase in FDP and D-Dimers took place. These values returned to the initial levels at h24. At 2h, the decrease in fibrinogen was significantly correlated with that of plasminogen (0.48, p=0.01), alpha2-antiplasmin (0.48, p=0.004), and factor XIII (0.44, p=0.01); the decrease in plasminogen was significantly correlated with those of antifibrinolytic components, factor XIII (0.47, p=0.02) and alpha2-antiplasmin (r=0.77, p0.001). These variations were independent of NIHSS. Cardioembolic infarcts showed a statistically significant greater h0-h2 decrease in plasminogen (p=0.04) and an h0-h2 increase in FDP (p=0.02). Poor outcome was linked to low plasminogen values at 2 and 24h.Supposed to be fibrin-specific, rt-PA induces a decrease in circulating fibrinogen, significantly linked to a decrease in plasminogen. A collateral increase in antifibrinolytic agents such as factor XIII and alpha2-antiplasmin is also observed. At 2h, a significant decrease in plasminogen and a significant increase in fibrin(ogen) degradation products (FDP) are observed in cardioembolic infarcts, and appear as early independent predictors of this aetiology. A low plasminogen value at 2h is potentially predictive of poor prognosis at 3months.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Antifibrinolytic
medicine.drug_class
medicine.medical_treatment
Fibrinogen
Fibrin
Fibrin Fibrinogen Degradation Products
Fibrinolytic Agents
Antifibrinolytic agent
Internal medicine
medicine
Humans
Thrombolytic Therapy
Aged
Aged, 80 and over
Hemostasis
alpha-2-Antiplasmin
Factor XIII
biology
business.industry
Plasminogen
Cerebral Infarction
Thrombolysis
Middle Aged
Ribonucleotides
Antifibrinolytic Agents
Surgery
Treatment Outcome
Neurology
Coagulation
Tissue Plasminogen Activator
biology.protein
Cardiology
Etiology
Female
Neurology (clinical)
business
Formycins
medicine.drug
Subjects
Details
- ISSN :
- 0022510X
- Volume :
- 349
- Database :
- OpenAIRE
- Journal :
- Journal of the Neurological Sciences
- Accession number :
- edsair.doi.dedup.....af100b5f276693615c23f6858e9abb18
- Full Text :
- https://doi.org/10.1016/j.jns.2014.12.029