Association of primary and secondary hemostasis biomarkers with acute ischemic stroke outcome in patients undergoing thrombectomy, with or without thrombolytics: Post-hoc analysis of the MR CLEAN-NOIV randomized clinical trial

• Published in: Journal of thrombosis and haemostasis
• Main Authors: Barakzie, Aarazo, Jansen, Gerard A.J., Cavalcante, Fabiano, Nagy, Magdolna, Dippel, Diederik W.J., van der Lugt, Aad, Roos, Yvo B.W. E.M., Majoie, Charles B.L. M., Cate, Hugo ten, de Maat, Moniek P.M.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 21.10.2024
• Subjects: Clinical and radiological outcomes; coagulation biomarkers; ischemic stroke; mechanical thrombectomy; thrombolysis; mechanical thrombectomy; thrombolysis; Clinical and radiological outcomes; ischemic stroke; coagulation biomarkers
• ISSN: 1538-7836; 1538-7836
• DOI: 10.1016/j.jtha.2024.10.008

Intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator (r-tPA) prior to endovascular thrombectomy (EVT) failed to improve treatment effect in acute ischemic stroke (AIS) patients compared to EVT alone. We investigated whether primary and secondary hemostasis biomarkers are associated with the effect of IV thrombolytics on clinical and radiological outcomes after EVT. In MR CLEAN-NOIV study, AIS patients were randomized to receive IVT plus EVT or EVT alone. We measured hemostatic biomarkers before and 24h post-reperfusion, to determine changes in biomarkers and to determine the association of the biomarkers with short-time stroke severity (National Institutes of Health Stroke Scale (NIHSS) score), long-term functional outcome (modified Rankin scale (mRS) score), post-EVT extended thrombolysis in cerebral infarction (eTICI) score, and final infarct size. This substudy included 214 of the 539 AIS patients who underwent IVT+EVT (N=108/266) or EVT alone (N=106/273). In the EVT group, low soluble glycoprotein VI (sGPVI) and high factor (F)VIII levels before treatment were associated with severe NIHSS-score at 24h and poor mRS-score at 90-day post-treatment, respectively. Also in this group, sGPVI levels 24h after treatment were negatively associated with final infarct size. In the IVT+EVT group, high fibrinogen before treatment was associated with good eTICI-score and low ADAMTS13 activity 24h post-treatment was associated with unfavorable mRS-score at 90-day. Our findings suggest that patients with high FVIII and fibrinogen and low sGPVI levels might be most suitable candidates for IVT+EVT, and that patients with low ADAMTS13 activity might be suitable for EVT alone.