PB1088 - Association between coagulation and neurologic outcomes in acute ischemic stroke patients from the MR CLEAN NO-IV trial

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Angelique Ceulemans, MSc

PhD-candidate
Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands

Co-Author(s)

Wv

Wim H. van Zwam

MD, PhD
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
Rv

Robert J. van Oostenbrugge

MD, PhD
Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
Moniek de Maat

Professor, MSc, PhD
Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
Rotterdam, Zuid-Holland, Netherlands
CM

Charles B. L. M. Majoie

MD, PhD
Department of Radiology and Nuclear Medicine, Amsterdam Neurosciences, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
YR

Yvo B. W. E. M. Roos

MD, PhD
Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
Hugo ten Cate, MD, PHD

MD, PhD
Departments of Internal Medicine and Biochemistry, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands
Henri M.H Spronk, PhD

Professor of Biochemistry of Atherothrombosis
Maastricht University
Maastricht, Limburg, Netherlands
Magdolna Nagy

PhD
Department of Biochemistry, Maastricht University Medical Center+, Maastricht, The Netherlands
Maastricht, Limburg, Netherlands

Background: Endovascular treatment (EVT) combined with best medical treatment (BMT), including intravenous thrombolysis (IVT), showed superiority over BMT alone in acute ischemic stroke (AIS) patients with large vessel occlusion of the anterior circulation. However, the treatment effect is largely attributable to EVT. In this respect, the added benefit of IVT remains elusive. Contrarily, hypercoagulability during AIS can cause further brain damage but may be reduced by the administration of antithrombotics.

Aims: To investigate the association between coagulation enzyme:inhibitor complexes with final infarct volume (FIV), modified Rankin Scale and mortality, and identify the effect modification of IVT on these outcome measures.

Methods: Plasma samples of three different time points (T0 = admission; T1 = 1 hour post-EVT; T2 = 24 hours post-EVT) of 118 patients, included in the MR CLEAN NO-IV trial, were available for analyses. Enzyme:inhibitor complexes were quantified with in-house validated enzyme-linked immunosorbent assays. Differences between enzyme:inhibitor complexes were assessed with Related-Samples Friedman’s two-way analysis of variance by ranks tests, and multivariable regression was used to investigate potential associations between enzyme:inhibitor complexes and outcome measures.

Results: There were significant differences between the three time points in Thrombin-antithrombin (AT) (p < 0.001), Factor (F)IXa-AT (p=0.001), FXa-AT (p < 0.001), FVIIa-AT (p=0.01), FXIIa-C1 Esterase Inhibitor (C1inh) (p < 0.001) and FXIIa-AT-C1inh (p < 0.01) (Figure1A). Similar results were found in the subgroup of patients that received IVT before EVT (Figure1B). Contrarily, the subgroup of patients who received EVT alone only showed significant differences in T-AT (p=0.01) and FXa-AT (p < 0.001) (Figure1C), suggesting effect modification by IVT. Neither Enzyme:inhibitor complexes nor the interaction of the complexes with IVT were significantly associated with FIV and clinical outcomes in the total population or subgroups.

Conclusion(s): Despite significant increases in enzyme:inhibitor complexes, attributable to IVT administration, there were no significant associations with FIV and clinical outcomes. Further research regarding enhanced coagulation in AIS warranted.