Dynamic change of coagulation and anticoagulation markers of patients with acute cerebral infarction during intravenous urokinase thrombolysis

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients: A single-center study of 391 cases

For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients.Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed.Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group (P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06-7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10-0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06-0.45 P = .000) were protective factors of hemorrhagic complications.For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.

The spatial distribution of the normal reference values of the activated partial thromboplastin time based on ArcGIS and GeoDA

We explored the variation and spatial distribution of the activated partial thromboplastin time (APTT) reference values of healthy people at different altitudes in China in order to develop a scientific basis for a unified standard. The APTT reference values of 49,020 healthy males (41-75 years old) and 32,447 healthy females (41-75 years old) were collected from 601 work units and 546 work units in China, respectively. The relationship between the APTT reference values and altitude was tested by correlation analysis. Linear regression analysis and curve analysis were employed to predict the APTT reference values in the whole country. Trend surface analysis, the variation function, kriging interpolation, and Getis-Ord Gi* statistic were utilized to reveal the spatial characteristics of the values. The result showed a significant positive correlation between the APTT reference values and altitude. The APTT values for females were prolonged for a greater amount of time than the males in several same areas in China. The spatial contact forms of the APTT reference values of healthy Chinese were mainly "high-high" and "low-low," which was in accord with the first law of geography. The APTT reference values still showed spatial autocorrelation and regional variation. The values were higher in the western and northern areas than in the eastern and southern areas of China. The APTT reference values of people aged 41-75 in China showed regional differences. The APTT reference values in one area can be estimated by using the best prediction model or can be obtained by the geographical distribution.

Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction

BACKGROUND

Intravenous thrombolysis is considered to be the standard reperfusion therapy for acute ischemic stroke, but its application is limited by high risk of hemorrhagic transformation (HT) after thrombolysis.

AIM

This study aimed to identify risk factors of HT after intravenous thrombolysis.

METHODS

Patients with acute ischemic stroke receiving rt-PA thrombolysis from February 2013 to January 2018 were retrospectively reviewed. They were divided into HT group and non-HT group based on cranial computed tomography. Data of all patients were collected and analysed by univariate analysis and stepwise logistic regression analysis.

RESULTS

A total of 403 patients were enrolled and their age ranged from 13 to 86 years, with an average age of 67.01 ± 31.88 years. 136 (33.7%) patients were females. The average time from disease onset to thrombolysis was 52.05 ± 20.12 min, and 46 patients (11.4%) had HT after thrombolysis. We found significant differences in activated partial thromboplastin time, fibrinogen value, platelet value and smoking before thrombolysis between HT and non-HT group (P < 0.05).

CONCLUSION

Smoking, prolongation of activated partial thromboplastin time, low fibrinogen levels and low platelet counts are associated with the risk of HT and could help the selection of thrombolytic patients to avoid HT.

Hematoma Expansion Following Intracerebral Hemorrhage: Mechanisms Targeting the Coagulation Cascade and Platelet Activation

Hematoma expansion (HE), defined as a greater than 33% increase in intracerebral hemorrhage (ICH) volume within the first 24 hours, results in significant neurological deficits, and enhancement of ICH-induced primary and secondary brain injury. An escalation in the use of oral anticoagulants has led to a surge in the incidences of oral anticoagulation-associated ICH (OAT-ICH), which has been associated with a greater risk for HE and worse functional outcomes following ICH. The oral anticoagulants in use include vitamin K antagonists, and direct thrombin and factor Xa inhibitors. Fibrinolytic agents are also frequently administered. These all act via differing mechanisms and thus have varying degrees of impact on HE and ICH outcome. Additionally, antiplatelet medications have also been increasingly prescribed, and result in increased bleeding risks and worse outcomes after ICH. Aspirin, thienopyridines, and GPIIb/IIIa receptor blockers are some of the most common agents in use clinically, and also have different effects on ICH and hemorrhage growth, based on their mechanisms of action. Recent studies have found that reduced platelet activity may be more effective in predicting ICH risk, hemorrhage expansion, and outcomes, than antiplatelet agents, and activating platelets may thus be a novel target for ICH therapy. This review explores how dysfunctions or alterations in the coagulation and platelet cascades can lead to, and/or exacerbate, hematoma expansion following intracerebral hemorrhage, and describe the mechanisms behind these effects and the drugs that induce them. We also discuss potential future therapy aimed at increasing platelet activity after ICH.

Evaluation of efficacy and safety of Reteplase and Alteplase in the treatment of hyper-acute cerebral infarction

Objective: The present study aimed to investigate the efficacy and safety of Reteplase (rPA) and Alteplase (rt-PA) in the treatment of hyper-acute cerebral infarction (CI).

Methods: Six hundred and eleven patients with hyper-acute CI selected from September 2014 to September 2016 were assigned into the aspirin, rt-PA, rPA, rt-PA + aspirin, and rPA + aspirin groups based on their willingness. The difference of efficacy in five groups were evaluated with National Institute of Health Stroke Scale (NIHSS), modified rankin scale (mRS), and Barthel Index (BI). Coagulation function, blood lipid, and hemodynamics were analyzed. The safety differences were compared by observing the adverse reactions.

Results: Compared with the rt-PA, rPA, and aspirin groups, NIHSS score, mRS score, the incidence of non- and symptomatic cerebral hemorrhage as well as the rate of adverse reactions were decreased, while BI were increased in the rt-PA + aspirin and rPA + aspirin groups after treatment. Compared with the rt-PA and rPA groups, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were lower, whereas the hematocrit, whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, erythrocyte electrophoresis time, fibrinogen, erythrocyte sedimentation rate (ESR), K value in blood sedimentation equation, and the comprehensive abnormality degree of blood rheology were higher in the rt-PA + aspirin and rPA + aspirin groups.

Conclusion: The efficacy and safety of rt-PA or rPA combined with aspirin in the treatment of hyper-acute CI were better than those of rPA or rt-PA monotherapy.

Dynamical levels of plasma F(1+2) and D-dimer in patients with acute cerebral infarction during intravenous urokinase thrombolysis

OBJECTIVE

To explore the value of dynamically monitored levels of plasma prothrombin fragment(1+2) (F(1+2)) and D-dimer in the process of thrombolysis with urokinase.

METHODS

Blood samples were collected at baseline and at hours 1, 2, 3, 6, 12, 24, 48, 72, and 96 after urokinase infusion finished. The levels of plasma F(1+2) and D-dimer of 45 patients who received urokinase intravenous infusion were assayed by ELISA and fluorescent immunoassay, and analysed dynamically with their clinical outcomes.

RESULTS

The levels of plasma F(1+2) and D-dimer in patients before urokinase thrombolysis were significantly higher than age- and gender-matched normal controls (all p<0.05). After urokinase infusion was finished, three kinds of dynamic changes of plasma F(1+2) and D-dimer with different clinical outcomes appeared. In effective subgroup (n=30), the plasma D-dimer increased quickly and reached to the peak at the third hour, remained at the higher level for more than 24 hours, and then decreased gradually; while plasma F(1+2) began to decrease at the second hour and promptly approached to its trough near the baseline, after 24 hours. In non-effective subgroup, the D-dimer was slightly higher than its baseline and much lower than that in the effective subgroup, and the most high level appeared at the sixth hour and decreased quickly; moreover, the peak of F(1+2) appeared at the third hour and remained at high level for more than 40 hours, and then decreased to the trough which was near the baseline. In cerebral hemorrhage subgroup, the D-dimer peak (2551 +/- 68 microg/l) appeared at the third hour, which was 1.5-fold higher than that in effective subgroup (1895 +/- 89 microg/l), 5.0-fold higher than that in non-effective subgroup (531 +/- 46 microg/l), and 6.0-fold higher than its baseline, and kept higher level for more than 72 hours; meanwhile, the F(1+2) decreased remarkably and reached the trough which was far below its baseline.

CONCLUSIONS

Plasma F(1+2) and D-dimer levels are closely related to the different clinical outcomes after urokinase thrombolysis. Thrombotic-fibrinolytic imbalance might be one of the main reasons which affected the prognosis of ischemia stroke. Dynamic assay of the two biomarkers in plasma besides clinical observation might be helpful to predict the early prognosis of acute ischemia stroke during the process of urokinase thrombolysis.

Expression patterns and action analysis of genes associated with blood coagulation responses during rat liver regeneration

AIM: To study the blood coagulation response after partial hepatectomy (PH) at transcriptional level.

METHODS: After PH of rats, the associated genes with blood coagulation were obtained through reference to the databases, and the gene expression changes in rat regenerating liver were analyzed by the Rat Genome 230 2.0 array.

RESULTS: It was found that 107 genes were associated with liver regeneration. The initially and totally expressing gene numbers occurring in initiation phase of liver regeneration (0.5-4 h after PH), G₀/G₁ transition (4-6 h after PH), cell proliferation (6-66 h after PH), cell differentiation and structure-function reconstruction (66-168 h after PH) were 44, 11, 58, 7 and 44, 33, 100, 71 respectively, showing that the associated genes were mainly triggered in the forepart and prophase, and worked at different phases. According to their expression similarity, these genes were classified into 5 groups: only up-, predominantly up-, only down-, predominantly down-, up- and down-regulation, involving 44, 8, 36, 13 and 6 genes, respectively, and the total times of their up- and down-regulation expression were 342 and 253, respectively, demonstrating that the number of the up-regulated genes was more than that of the down- regulated genes. Their time relevance was classified into 15 groups, showing that the cellular physiological and biochemical activities were staggered during liver regeneration. According to gene expression patterns, they were classified into 29 types, suggesting that their protein activities were diverse and complex during liver regeneration.

CONCLUSION: The blood coagulation response is enhanced mainly in the forepart, prophase and anaphase of liver regeneration, in which the response in the forepart, prophase of liver regeneration can prevent the bleeding caused by partial hepatectomy, whereas that in the anaphase contributes to the structure-function reorganization of regenerating liver. In the process, 107 genes associated with liver regeneration play an important role.