Abstract
Objective: To determine the association between baseline ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) antigen level and 90-days clinical outcome in patients with acute ischemic stroke (AIS) receiving recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods: AIS patients receiving rt-PA thrombolytic therapy from Huashan Hospital and Fifth People's Hospital of Shanghai, China in 2014–2017 were consecutively enrolled. Blood samples for ADAMTS13 tests were drawn before intravenous rt-PA administration. The primary outcome was defined as the poor functional outcome of modified Rankin Scale (mRS) >2 at 90-days follow-up. Secondary outcome was hemorrhagic transformation after rt-PA therapy. Moreover, for AIS patients with large vessel occlusion from Huashan Hospital, the association between baseline ADAMTS13 level and cerebral collateral flow was also assessed.Results: A total of 163 AIS patients (median age 66.2 years, 63.8% male) were included. Baseline ADAMTS13 level was marginally decreased in patients with 90-days mRS >2 than in those with mRS ≤ 2 (mean ± SD, 1458.4 ± 323.3 vs. 1578.3 ± 395.4 ng/mL, p = 0.046). However, no difference of ADAMTS13 level was found after adjusting for age, history of atrial fibrillation, glycemia, baseline NIHSS score and TOAST classification (p = 0.43). We found no difference in ADAMTS13 level between patients with parenchymal hemorrhage after rt-PA therapy and those without (p = 0.44). Among 66 patients with large vessel occlusion, there was also no association between ADAMTS13 level and cerebral collateral flow in multivariable analyses.Conclusion: In our cohort, blood ADAMTS13 antigen level before rt-PA therapy could not be used as an independent biomarker in predicting clinical outcomes of AIS patients at 90 days.
Highlights
Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after the onset of stroke has been the major treatment for acute ischemic stroke (AIS) [1]
We aimed to examine whether low ADAMTS13 antigen level before recombinant tissue plasminogen activator (rt-PA) treatment [1] could predict functional outcomes 90 days after stroke; [2] could predict hemorrhagic transformation; [3] was associated with poor collateral flow in a subset of AIS patients with large vessel occlusion
The primary outcome was defined as the poor functional outcome at 90-days follow-up, which was recorded by a trained neurologist blinded to patient baseline information using a validated telephone script
Summary
Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) within 4.5 h after the onset of stroke has been the major treatment for acute ischemic stroke (AIS) [1]. It is strongly associated with an increased probability of survival without handicap and dependency at 3 months after ischemic stroke [2, 3]. Absence of ADAMTS13 exacerbates outcomes of ischemia or reperfusion injury [11, 12], while injecting recombinant ADAMTS13 reduces rt-PA-associated hemorrhage [13].
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