Abstract
Background: Fibrin degradation products (FDPs) are fragments released by the plasmin-mediated degradation of fibrinogen or fibrin. Whether plasma levels of these fragments can predict the thrombolytic effect of recombinant tissue plasminogen activator (r-tPA) remains unknown.Methods: We performed a hospital-based study of patients with acute ischemic stroke (AIS) to explore the relationship between FDP levels at admission and the NIH Stroke Scale (NIHSS) score 1 h after thrombolysis treatment. In this retrospective, single-center study, the data of all patients with AIS who received r-tPA treatment at Beijing Tiantan Hospital from January 2019 to October 2020 were collected and analyzed. Demographic and clinical data, including laboratory examinations, were also analyzed.Results: A total of 339 patients with AIS were included in this study. Of these, 151 showed favorable effects of r-tPA, and 188 showed unsatisfactory effects at 1 h after thrombolysis. Overall, we found an inverse relationship between the FDPs levels at admission and the NIHSS score. A significant difference was observed when using the interquartile range of the FDPs levels (1.31 μg/mL) as a cutoff value (P = 0.003, odds ratio [OR] = 1.95, 95% confidence interval [CI]: 1.26–3.01), even after adjusting for confounding factors (P = 0.003, OR = 2.23, 95% CI: 1.31–3.77). In addition, significant associations were observed in the tertile (T3) and quartile (Q3, Q4) FDP levels when compared with T1 or Q1. A nomogram was also employed to create a model to predict an unsatisfactory effect of r-tPA. We found that FDP levels, white blood cell count, age, D-dimer level, and body mass index could influence the thrombolytic effect of r-tPA.Conclusion: In conclusion, the present study demonstrated that the levels of FDPs at admission can be used as a prognostic factor to predict the curative effect of r-tPA.
Highlights
Acute ischemic stroke (AIS) is a major cause of mortality and morbidity worldwide [1, 2]
When using the Fibrin degradation products (FDPs) level (1.31 ug/mL) as a cutoff value, we found a significant association between FDP levels and the thrombolysis effect (P = 0.003, odds ratios (ORs) = 1.95, 95% confidence intervals (CIs): 1.26–3.01), even after adjusting for confounding factors (P = 0.003, OR = 2.23, 95% CI: 1.31–3.77)
The tertile data cutoffs were T1 < 1.09, T2 = 1.09–1.72, and T3 > 1.72; compared with T1, we found that patients with FDP levels in T3 showed a correlation with the recombinant tissue plasminogen activator (r-tPA) thrombolysis effect (P = 0.008, OR = 2.06, 95% CI: 1.21–3.51; adjusting for confounding factors, P = 0.003, OR = 2.70, and 95% CI: 1.39– 5.26)
Summary
Acute ischemic stroke (AIS) is a major cause of mortality and morbidity worldwide [1, 2]. A time-sensitive medical emergency, it is estimated to result in the death of ∼1.9 million neurons per minute without treatment [3]. Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) is an effective treatment for patients with AIS [4, 5]. Intravenous r-tPA (alteplase) administered in the early period (≤4.5 h) is recognized as a mainstay of the AIS treatment strategy [4, 6, 7]. It is vital that the attending physician be able to make a quick assessment and prediction of outcome under tight time constraints [8, 9]. Whether plasma levels of these fragments can predict the thrombolytic effect of recombinant tissue plasminogen activator (r-tPA) remains unknown
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