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    Oral Communication

    Arterial Thromboembolism

    Cerebrovascular Disease: Bench to Bedside

    OC 03.3 - Effect of intravenous tPA treatment on hemostatic factors in relation to outcome in acute ischemic stroke patients undergoing thrombectomy

    Saturday, June 24, 2023
    13:30 – 13:45 ET
    Room: 710B
    Session Available As: On-Demand

      Presenting Author(s)

    • Aarazo Barakzie, MSc

      MSc. Ph.D. student
      Department of Hematology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
      Rotterdam, Zuid-Holland, Netherlands

      • Co-Author(s)

    • GA

      Gerard A. J. Jansen

      Internist hematologist
      Department of Hematology, Erasmus MC, University Medical Center
      Rotterdam, Zuid-Holland, Netherlands

    • FC

      Fabiano Cavalcante

      Dr. MD. neurologist
      Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
      Amsterdam, Zuid-Holland, Netherlands

    • Magdolna Nagy, PhD

      Postdoctoral Researcher
      Coagulation Profile, Maastricht, the Netherlands
      Maastricht, Limburg, Netherlands

    • DW

      Diederik W.J. Dippel

      Prof. Dr. neurologist
      Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
      Rotterdam, Zuid-Holland, Netherlands

    • AV

      Aad Van Der Lugt

      Dr. Prof. Radiologist
      Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
      Rotterdam, Zuid-Holland, Netherlands

    • YB

      Yvo B. W. E. M. Roos

      Prof. MD. PhD Neurologist
      Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
      Amsterdam, Noord-Holland, Netherlands

    • CB

      Charles B. L. M. Majoie

      Professor of Neuroradiology
      Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • Hugo ten Cate, MD, PhD, FAHA (he/him/his)

      Professor, MD, PhD
      Thrombosis Expertise Center, Heart & Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
      Maastricht, Limburg, Netherlands

    • Moniek P.M. de Maat, PhD

      Professor
      Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
      Rotterdam, Zuid-Holland, Netherlands

    Background: Patients with acute ischemic stroke (AIS) are treated with intravenous tPA (IVT), followed by thrombectomy (EVT). Recently, the MR CLEAN NOIV trial showed no beneficial effect of IVT before EVT compared to EVT alone, indicating a need for biomarkers that predict clinical outcome. We postulate that biomarkers of hemostasis and fibrinolysis indicate the efficacy of thrombolysis.

    Aims: To study the impact of intravenous tPA on hemostatic biomarkers in relation to outcome in AIS patients undergoing EVT.

    Methods: We studied 214 of the 539 AIS patients included in MR CLEAN-NOIV trial who underwent IVT followed by EVT (N=108/266) or EVT alone (N=106/273). Blood samples were collected on admission and 24h after reperfusion. Selected hemostatic markers, including von Willebrand factor (VWF), ADAMTS13 (A disintegrin and metalloprotease with thrombospondin 1 repeats 13 (VWF-cleaving protease)), ß-thromboglobulin (ß-TG), soluble glycoprotein VI (sGPVI), Factor VIII (FVIII), Fibrinogen (FBG), endogenous thrombin potential (ETP), tissue plasminogen activator (tPA), d-dimer (DD), and clot lysis time (CLT) were measured in all blood samples and correlated with the 90 days outcome measured with the post-event modified Rankin Scale (mRS).

    Results: In patients with EVT alone, ADAMTS13, ß-TG, FVIII, FBG, ETP, and CLT values were significantly increased at 24h compared to on admission values. In patients with IVT plus EVT, ß-TG, FVIII, and DD values were significantly increased and sGPVI significantly decreased at 24h (Fig. 1). VWF levels at 24h after IVT followed by EVT were significantly increased and ADAMTS13 activity was significantly decreased in patients with unfavorable outcome compared to patients with favorable outcome (Table 1).

    Conclusion(s): Treatment with IVT prior to EVT led to increased VWF and decreased ADAMTS13 values which were associated with poor outcome, implicating a more prominent role of endothelial and platelet activation.

    Learning Objectives:

    • Upon completion, participant will be able to define hemostatic markers for improving diagnosis of ischemic stroke
    • Upon completion, participant will be able to identify hemostatic markers associated with poor outcomes
    • Upon completion, participant will be able to incoporate the hemostatic markers in guiding treatment decisions