Clinical Significance and Dynamic Change of Coagulation Parameters in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Abstract

Objective Investigations on coagulation parameters including fibrinogen (Fbg), fibrinogen degradation products (FDP), and D-dimer in ischemic stroke patients treated with intravenous thrombolysis are insufficient. We aimed to investigate the association between in-hospital clinical outcomes and the coagulation parameters at different time points in ischemic stroke patients treated with intravenous tissues plasminogen activator (IV tPA). Methods We retrospectively enrolled patients who received IV tPA therapy within 4.5 h from symptoms onset. Demographics, clinical characteristics, imaging measures, and the discharge mRS score were collected. Multivariable logistic regression analyses were performed to test whether coagulation parameters were independent predictors for the in-hospital clinical outcomes. We also employed machine learning models to investigate whether coagulation parameters were able to improve the prediction of favorable functional outcomes. Results One hundred and fifty-two patients treated with IV tPA were included. Among the coagulation parameters, low D-dimers at 48 h proved to be an independent predictor of favorable functional outcome (adjusted odd ratio 0.24, 95% confidential intervals 0.06-0.92, P = 0.04). The AUC of D-dimer at 48 h to predict favorable functional outcome was 0.73 (0.60-0.87) and the optimal cut-off value was 0.92 (sensitivity 0.69, specificity 0.78). Machine learning models with D-dimer at 48 h had superior performance in predicting favorable functional outcomes and among the input variables in the machine learning models, D-dimer at 48 h showed the highest weight in predicting mRS 0-1 at discharge (38.44%). Conclusion Increased levels of D-dimer at 48 h was associated with lower proportion of favorable functional outcomes in acute ischemic stroke patients with intravenous thrombolysis.

The progression of surgical intervention for arterial reocclusion after mechanical thrombectomy for acute cerebral infarction

“…Furthermore, Gangshuo Li identifies elevated D-dimer as an independent risk factor for AR. 31 IVT can lead to fibrin deposition and heightened excitability of the anticoagulant system, indirectly causing thrombosis, and postoperative D-dimer level monitoring can predict AR risk post-MT.…”

“…Stroke severity, more accurately reflecting thrombus burden than occlusion location on transcranial Doppler (TCD), suggests that urgent carotid ultrasound combined with TCD may identify patients at high risk for AR, aiding in AR prevention postrevascularization. Furthermore, Gangshuo Li identifies elevated D-dimer as an independent risk factor for AR 31 . IVT can lead to fibrin deposition and heightened excitability of the anticoagulant system, indirectly causing thrombosis, and postoperative D-dimer level monitoring can predict AR risk post-MT.…”

Machine learning identifies novel coagulation genes as diagnostic and immunological biomarkers in ischemic stroke

“…Coagulation is a complex process mediated by multiple genes and pathways [8]. In recent years, with the deepening understanding of the physiological and pathological functions of the members of the coagulation system, it has been found that the members of the coagulation system play an important role in the pathogenesis of IS [9][10][11]. Moreover, studies have shown that polymorphisms of coagulation genes (CGs) are associated with the risk of IS.…”