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Gallego-Fabrega C, Temprano-Sagrera G, Cárcel-Márquez J, Muiño E, Cullell N, Lledós M, Llucià-Carol L, Martin-Campos JM, Sobrino T, Castillo J, Millán M, Muñoz-Narbona L, López-Cancio E, Ribó M, Alvarez-Sabin J, Jiménez-Conde J, Roquer J, Tur S, Obach V, Arenillas JF, Segura T, Serrano-Heras G, Marti-Fabregas J, Freijo-Guerrero M, Moniche F, Castellanos MDM, Morrison AC, Smith NL, de Vries PS, Fernández-Cadenas I, Sabater-Lleal M. A multitrait genetic study of hemostatic factors and hemorrhagic transformation after stroke treatment. J Thromb Haemost 2024; 22:936-950. [PMID: 38103737 PMCID: PMC11103592 DOI: 10.1016/j.jtha.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Thrombolytic recombinant tissue plasminogen activator (r-tPA) treatment is the only pharmacologic intervention available in the ischemic stroke acute phase. This treatment is associated with an increased risk of intracerebral hemorrhages, known as hemorrhagic transformations (HTs), which worsen the patient's prognosis. OBJECTIVES To investigate the association between genetically determined natural hemostatic factors' levels and increased risk of HT after r-tPA treatment. METHODS Using data from genome-wide association studies on the risk of HT after r-tPA treatment and data on 7 hemostatic factors (factor [F]VII, FVIII, von Willebrand factor [VWF], FXI, fibrinogen, plasminogen activator inhibitor-1, and tissue plasminogen activator), we performed local and global genetic correlation estimation multitrait analyses and colocalization and 2-sample Mendelian randomization analyses between hemostatic factors and HT. RESULTS Local correlations identified a genomic region on chromosome 16 with shared covariance: fibrinogen-HT, P = 2.45 × 10-11. Multitrait analysis between fibrinogen-HT revealed 3 loci that simultaneously regulate circulating levels of fibrinogen and risk of HT: rs56026866 (PLXND1), P = 8.80 × 10-10; rs1421067 (CHD9), P = 1.81 × 10-14; and rs34780449, near ROBO1 gene, P = 1.64 × 10-8. Multitrait analysis between VWF-HT showed a novel common association regulating VWF and risk of HT after r-tPA at rs10942300 (ZNF366), P = 1.81 × 10-14. Mendelian randomization analysis did not find significant causal associations, although a nominal association was observed for FXI-HT (inverse-variance weighted estimate [SE], 0.07 [-0.29 to 0.00]; odds ratio, 0.87; 95% CI, 0.75-1.00; raw P = .05). CONCLUSION We identified 4 shared loci between hemostatic factors and HT after r-tPA treatment, suggesting common regulatory mechanisms between fibrinogen and VWF levels and HT. Further research to determine a possible mediating effect of fibrinogen on HT risk is needed.
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Affiliation(s)
- Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. https://twitter.com/FabregaGallego
| | - Gerard Temprano-Sagrera
- Genomics of Complex Disease Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Neurology Unit, Hospital Universitari MútuaTerrassa, Terrassa, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jesús M Martin-Campos
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Department of Neurology, Hospital Clínico Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - Mònica Millán
- Department of Neuroscience, Hospital Universitario Hermanos Trias y Pujol (HUGTP), Badalona, Spain
| | - Lucía Muñoz-Narbona
- Department of Neuroscience, Hospital Universitario Hermanos Trias y Pujol (HUGTP), Badalona, Spain
| | - Elena López-Cancio
- Stroke Unit, Neurology Department, Hospital Universitario Central de Asturias (HUCA), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitario Valle de Hebrón (HUVH), Barcelona, Spain
| | - Jose Alvarez-Sabin
- Department of Neurology, Hospital Universitario Valle de Hebrón (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, Neurovascular Research Group, Instituto de investigaciones médicas Hospital del Mar (IMIM) Hospital del Mar, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group, Instituto de investigaciones médicas Hospital del Mar (IMIM) Hospital del Mar, Barcelona, Spain
| | - Silvia Tur
- Department of Neurology, Hospital Universitario Son Espases (HUSE), Mallorca, Spain
| | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain
| | - Tomas Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete (CHUA), Universidad de Castilla-La Mancha (UCLM), Albacete, Spain
| | - Gemma Serrano-Heras
- Research Unit, Complejo Hospital Universitario de Albacete (CHUA), Albacete, Spain
| | - Joan Marti-Fabregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | | | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Maria Del Mar Castellanos
- Department of Neurology, Hospital Universitario de A Coruña (CHUAC), Biomedical Research Institute, A Coruña, Spain
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, Washington, USA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA; Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, Washington, USA
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
| | - Maria Sabater-Lleal
- Genomics of Complex Disease Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Xu X, Song Y, Cao W, Bai X, Wang X, Gao P, Chen J, Chen Y, Yang B, Wang Y, Chen F, Ma Q, Yu B, Jiao L. Alterations of Hemostatic Molecular Markers During Acute Large Vessel Occlusion Stroke. J Am Heart Assoc 2024; 13:e032651. [PMID: 38293908 PMCID: PMC11056158 DOI: 10.1161/jaha.123.032651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND This study aimed to investigate regional levels of TAT (thrombin-antithrombin complex), PIC (plasmin-α2 plasmin inhibitor complex), t-PAIC (tissue plasminogen activator-plasminogen activator inhibitor complex), sTM (soluble thrombomodulin), and D-dimer, along with their associations with clinical and procedural characteristics in patients with acute ischemic stroke undergoing endovascular thrombectomy. METHODS AND RESULTS We retrospectively analyzed 166 consecutive patients with acute ischemic stroke (62±11.54 years of age, 34.3% women) using prospectively maintained clinical databases and blood samples from local ischemic (proximal to thrombus) and systemic (femoral artery, self-control) arterial compartments. Levels of TAT, PIC, t-PAIC, and D-dimer were significantly elevated, whereas sTM was significantly reduced, in local ischemic regions compared with their systemic levels. Each 1-unit increase in ischemic TAT (adjusted odds ratio [aOR], 1.086 [95% CI, 1.03-1.145]; P=0.002; area under the curve [AUC], 0.833) and PIC (aOR, 1.337 [95% CI, 1.087-1.644]; P=0.006; AUC, 0.771) correlated significantly with higher symptomatic intracranial hemorrhage risk. Additionally, each 1-unit increase in ischemic TAT (aOR, 1.076 [95% CI, 1.016-1.139]; P=0.013; AUC, 0.797), PIC (aOR, 1.554 [95% CI, 1.194-2.022]; P=0.001; AUC, 0.798), and sTM (aOR, 0.769 [95% CI, 0.615-0.961]; P=0.021; AUC, 0.756) was significantly associated with an increased risk of an unfavorable 90-day outcome (modified Rankin scale of 3-6). These hemostatic molecules, individually or combined, significantly improved the predictive power of conventional risk factors, as evidenced by significant increases in net reclassification improvement and integrated discrimination improvement (all P<0.01). CONCLUSIONS We observed a hyperactive state of the coagulation-fibrinolysis system within the local ischemic region during hyperacute stroke. Rapid automated measurement of hemostatic molecular markers, particularly TAT, PIC, and sTM, during intra-arterial procedures may provide additional information for stroke risk stratification and therapeutic decision-making, and warrants further investigation.
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Affiliation(s)
- Xin Xu
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
- Jinan Hospital of Xuanwu HospitalCapital Medical UniversityJinanShandongChina
| | - Yiming Song
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Wenbo Cao
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Xinyu Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Peng Gao
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Jian Chen
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Bin Yang
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
| | - Fei Chen
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Bo Yu
- Zhejiang Pushkang Biotechnology Co., LtdShaoxingZhejiangChina
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
- China International Neuroscience Institute (China‐INI)BeijingChina
- Jinan Hospital of Xuanwu HospitalCapital Medical UniversityJinanShandongChina
- Department of Interventional Neuroradiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
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Zhao X, Yang S, Lei R, Liu Y, Duan Q, Li J, Sun L. Value of novel thrombotic markers for predicting occurrence of the malignant cerebral artery infarction: a prospective clinical study. Front Neurol 2023; 14:1238742. [PMID: 38099069 PMCID: PMC10719929 DOI: 10.3389/fneur.2023.1238742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Objective This study investigated the diagnostic performance of thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (t-PAIC), and thrombomodulin (TM) in predicting the progression of massive cerebral infarction to the malignant cerebral artery infarction. Method A total of 71 patients with massive cerebral infarction confirmed by imaging examination were divided into malignant cerebral artery infarction group (MCAI) and non-malignant cerebral artery infarction group (NMCAI) based on whether they progressed to MCAI after admission. TAT, PIC, t-PAIC, and TM were measured immediately after admission. The predictive performance was analyzed by the receiver characteristic operating curve (ROC). Result The median plasma concentrations of TM, PIC, TAT, and t-PAIC in the MCAI patients at admission were 10.65 IU/mL, 1.17 μg/mL, 12.25 ng/mL, and 13.85 ng/mL, respectively, which were higher than those in the NMCAI patients (9.00 IU/mL, 1.07 μg/mL, 4.60 ng/mL, and 8.70 ng/mL), and the difference was statistically significant (p = 0.045, p = 0.035, p = 0.004, and p = 0.003). Elevated plasma t-PAIC concentration was shown to be an independent risk factor for progression of massive cerebral infarction to MCAI (OR = 1.131) by multivariate logistic regression analysis. ROC curve analysis showed that t-PAIC was the best predictor of MCAI (AUC = 74.7%), with a sensitivity of 75.0% and specificity of 75.9% when t-PAIC concentration was ≥12.4 ng/mL; TAT had the highest specificity in predicting MCAI, with a specificity of 90.7% when the TAT concentration was ≥13.5 ng/mL. Conclusion The detection of PIC, TAT, t-PAIC, and TM is a comprehensive assessment of vascular endothelial damage and activation of the coagulation and fibrinolytic systems and has predictive value for poor prognosis in patients with MCAI. The widespread use of these tests will likely greatly improve the early diagnosis rate of MCAI.
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Affiliation(s)
- Xiaoxia Zhao
- Department of Neurology, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Siyu Yang
- Department of Neurology, Fifth Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruining Lei
- Department of Neurology, Fifth Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Liu
- Department of Neurology, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Qiaoyan Duan
- Clinical Laboratory, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Jundong Li
- Medical Imaging Department, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Lei Sun
- Zhao Furun Famous Doctor Studio in Shanxi Province, Taiyuan, China
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Zhao X, Yang S, Lei R, Duan Q, Li J, Meng J, Sun L. Clinical study on the feasibility of new thrombus markers in predicting massive cerebral infarction. Front Neurol 2023; 13:942887. [PMID: 36761916 PMCID: PMC9905744 DOI: 10.3389/fneur.2022.942887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Objective This study investigated the diagnostic performance of the thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (t-PAIC), and thrombomodulin (TM) in the early identification of massive cerebral infarction. Method A total of 423 patients with cerebral infarction confirmed by imaging examination were divided into the massive cerebral infarction (MCI) group and the non-massive cerebral infarction (NMCI) group. TAT, PIC, t-PAIC, and TM were measured immediately after admission. The diagnostic performance was analyzed by the receiver characteristic operating curve (ROC). Result The median plasma concentrations of TAT, PIC, and t-PAIC in patients with MCI at early onset were 5.10 ng/ml, 1.11 μg/ml, and 8.80 ng/ml, respectively, which were higher than those in patients with NMCI (2.20 ng/ml, 0.59 μg/ml, and 7.35 ng/ml), and the difference was statistically significant (P < 0.001). TAT was shown to be an independent risk factor for the development of massive cerebral infarction by a multivariate logistic regression analysis (OR = 1.138). A ROC curve analysis showed that PIC had the best performance in identifying MCI at an early stage (AUC = 82.8%), with a sensitivity of 80.7% and a specificity of 76.2% when the PIC concentration was ≥0.8 μg/ml; TAT had the highest specificity in identifying MCI, with a specificity of 80.6% when the TAT concentration was ≥3.97 ng/ml. Conclusion The detection of PIC, TAT, t-PAIC, and TM is a comprehensive assessment of vascular endothelial damage and activation of the coagulation and fibrinolytic systems and has diagnostic value for early identification of patients with MCI, which, together with its ease of detection, can be used as a plasma marker for early identification of large vessel occlusion.
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Affiliation(s)
- Xiaoxia Zhao
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China,*Correspondence: Xiaoxia Zhao ✉
| | - Siyu Yang
- Department of Neurology, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ruining Lei
- Department of Neurology, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qiaoyan Duan
- Clinical Laboratory, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Jundong Li
- Medical Imaging Department, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Jiangtao Meng
- Department of Neurology, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lei Sun
- Zhao Furun Famous Doctor Studio in Shanxi Province, Taiyuan, Shanxi, China
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Sanders CB, Knisely K, Rathfoot C, Edrissi C, Nathaniel T. Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy. Clin Appl Thromb Hemost 2022; 28:10760296221116347. [PMID: 36278505 PMCID: PMC9596934 DOI: 10.1177/10760296221116347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Acute ischemic stroke (AIS) patients with congestive heart failure (HF) that present with various risk factors are less likely to receive recombinant tissue plasminogen activator (rtPA). The risk factors associated with excluding AIS patients with congestive heart failure (AIS-HF) from rtPA therapy have not been fully established. Methods: Retrospective data for 5469 AIS patients comprised of 590 AIS patients with HF and 4879 AIS patients without HF were collected from a regional stroke registry between January 2010 and June 2016. Baseline risk factors were analyzed using logistic regression analysis to determine the risk factors associated with rtPA exclusion in AIS-HF patients. Results: In the adjusted analysis, AIS-HF patients that that did not receive rtPA were more likely to be older (OR = 0.982, 95% CI, 0.966-1, P = .020), presented with coronary artery disease (OR = 0.618, 95% CI, 0.391-0.98, P = .040), and with an elevated INR (OR = 0.326, 95% CI, 0.129-0.82, P = .018). AIS-HF patients that were included for rtPA therapy were more likely to show improvement in ambulatory status (OR = 1.69, 95% CI, 1.058-2.7, P = .028). The discriminating power of the model was strong with an area under the curve (AUROC) = 0.668 (95% CI, 0.611-0.724, P < .001). Conclusion: Our study establishes the associations between stroke risk factors and exclusion from rtPA therapy. This finding suggests the need to develop management strategies for older HF patients with carotid artery disease and an elevated INR to improve their eligibility for rtPA treatment following an acute ischemic stroke.
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Affiliation(s)
| | - Krista Knisely
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Chase Rathfoot
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Camron Edrissi
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
| | - Thomas Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC, USA
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