TY - JOUR
T1 - Association between coagulation activity and clinical and imaging outcomes in acute ischemic stroke patients - A sub-study of the MR CLEAN NO-IV trial
AU - Ceulemans, Angelique
AU - Barakzie, Aarazo
AU - Spronk, Henri M.H.
AU - de Maat, Moniek P.M.
AU - van Beusekom, Heleen M.M.
AU - Taha, Aladdin
AU - Emmer, Bart J.
AU - Roos, Yvo B.W.E.M.
AU - Dippel, Diederik W.J.
AU - Majoie, Charles B.L.M.
AU - van Zwam, Wim H.
AU - ten Cate, Hugo
AU - van Oostenbrugge, Robert J.
AU - Nagy, Magdolna
N1 - Funding Information:
The MR CLEAN NO-IV study was funded by the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which is supported by the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); the Brain Foundation Netherlands (HA2015.01.06); the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences and Health to stimulate public\u2013private partnerships (LSHM17016); and unrestricted funding by Stryker, Medtronic, and Cerenovus.
Funding Information:
MN received funding from the Dutch Heart Foundation (03-006-2022-052). The present study did not receive any additional funding.We acknowledge the support of the Netherlands Cardiovascular Research Initiative which is supported by the Dutch Heart Foundation (CVON2015-01: CONTRAST), the support of the Brain Foundation Netherlands (HA2015.01.06), and the support of Health~Holland, Top Sector Life Sciences & Health (LSHM17016) of Medtronic and Cerenovus. Amsterdam UMC, location AMC, and Erasmus MC received additional unrestricted funding on behalf of CONTRAST, for the execution of MR CLEAN-NO IV of Stryker. Furthermore, we acknowledge the contributions of the MR CLEAN-NO IV Investigators.
Funding Information:
We acknowledge the support of the Netherlands Cardiovascular Research Initiative which is supported by the Dutch Heart Foundation ( CVON2015-01 : CONTRAST), the support of the Brain Foundation Netherlands ( HA2015.01.06 ), and the support of Health~Holland, Top Sector Life Sciences & Health ( LSHM17016 ) of Medtronic and Cerenovus. Amsterdam UMC , location AMC, and Erasmus MC received additional unrestricted funding on behalf of CONTRAST, for the execution of MR CLEAN-NO IV of Stryker.
Funding Information:
MN received funding from the Dutch Heart Foundation ( 03-006-2022-0052 ). The present study did not receive any additional funding.
Publisher Copyright:
© 2024 The Authors
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Background: The MR CLEAN NO-IV trial showed neither superiority nor noninferiority of endovascular treatment (EVT) alone compared to intravenous thrombolysis (IVT; Alteplase) before EVT in acute ischemic stroke (AIS) patients with large vessel occlusion of the anterior circulation. Although the treatment effect is largely attributable to EVT, IVT may affect hypercoagulability during AIS. Aims: To investigate the association between activated coagulation and final infarct volume and clinical outcomes (modified Rankin Scale 3–6 and mortality 90 days post-EVT), and whether this effect is modified by IVT administration. Methods: Enzyme-linked immunosorbent assays were used to quantify activated coagulation markers (activated coagulation factor (F) XIIa-C1 esterase inhibitor (C1inh); FXIIa-antithrombin (AT), FXIa-C1inh, FXIa-AT, FIXa-AT, FXa-AT, T-AT, FVIIa-AT) in plasma samples obtained on admission (T0), 1 h post-EVT (T1) and 24 h post-EVT (T2). Multivariable regressions were performed to investigate the associations and effect modification. Results: In the total cohort of 116 patients, a significant increase at T1 was seen in FIXa-AT (p = .001), FXa-AT (p < .001), T-AT (p < .001), and FVIIa-AT (p = .012), while there was a significant increase at T2 in FXIIa-C1inh (p < .001). Similar results were seen in the IVT+EVT subgroup. The EVT alone subgroup showed a significant temporary increase at T1 in FXa-AT (p < .001) and T-AT (p = .014). Neither the enzyme:inhibitor complexes nor the interaction with IVT were significantly associated with the outcome measures. Conclusion: Despite temporary significant increases in enzyme:inhibitor complexes in the IVT+EVT group, but not in the EVT alone group, there were no significant associations with final infarct volume and clinical outcomes.
AB - Background: The MR CLEAN NO-IV trial showed neither superiority nor noninferiority of endovascular treatment (EVT) alone compared to intravenous thrombolysis (IVT; Alteplase) before EVT in acute ischemic stroke (AIS) patients with large vessel occlusion of the anterior circulation. Although the treatment effect is largely attributable to EVT, IVT may affect hypercoagulability during AIS. Aims: To investigate the association between activated coagulation and final infarct volume and clinical outcomes (modified Rankin Scale 3–6 and mortality 90 days post-EVT), and whether this effect is modified by IVT administration. Methods: Enzyme-linked immunosorbent assays were used to quantify activated coagulation markers (activated coagulation factor (F) XIIa-C1 esterase inhibitor (C1inh); FXIIa-antithrombin (AT), FXIa-C1inh, FXIa-AT, FIXa-AT, FXa-AT, T-AT, FVIIa-AT) in plasma samples obtained on admission (T0), 1 h post-EVT (T1) and 24 h post-EVT (T2). Multivariable regressions were performed to investigate the associations and effect modification. Results: In the total cohort of 116 patients, a significant increase at T1 was seen in FIXa-AT (p = .001), FXa-AT (p < .001), T-AT (p < .001), and FVIIa-AT (p = .012), while there was a significant increase at T2 in FXIIa-C1inh (p < .001). Similar results were seen in the IVT+EVT subgroup. The EVT alone subgroup showed a significant temporary increase at T1 in FXa-AT (p < .001) and T-AT (p = .014). Neither the enzyme:inhibitor complexes nor the interaction with IVT were significantly associated with the outcome measures. Conclusion: Despite temporary significant increases in enzyme:inhibitor complexes in the IVT+EVT group, but not in the EVT alone group, there were no significant associations with final infarct volume and clinical outcomes.
KW - Acute ischemic stroke
KW - Coagulation
KW - Endovascular treatment
KW - Intravenous thrombolysis
U2 - 10.1016/j.thromres.2024.109212
DO - 10.1016/j.thromres.2024.109212
M3 - Article
SN - 0049-3848
VL - 245
JO - Thrombosis Research
JF - Thrombosis Research
M1 - 109212
ER -