Quantitatively monitoring acute ischemic stroke patients post recombinant tissue plasminogen activator treatment

Yonge Liu; Jingting Ma; Qiyang Shi; Shimeng Xin; Haojia Yu; Zilong Liu; Chunsong Pang; Feng Dong; Jinghan Wang

doi:10.1002/hsr2.218

Quantitatively monitoring acute ischemic stroke patients post recombinant tissue plasminogen activator treatment

Health Sci Rep. 2020 Dec 21;4(1):e218. doi: 10.1002/hsr2.218. eCollection 2021 Mar.

Authors

Yonge Liu¹, Jingting Ma¹, Qiyang Shi¹, Shimeng Xin¹, Haojia Yu¹, Zilong Liu¹, Chunsong Pang¹, Feng Dong¹, Jinghan Wang¹

Affiliation

¹ Emergency Laboratory The second hospital of Dalian Medical University Dalian China.

Abstract

Background and aims: Thrombolytic therapy is widely used to treat acute ischemic stroke (AIS) patients. As intracerebral hemorrhage is a life-threatening complication of this therapy, monitoring the fibrinolytic and coagulation systems is imperative. However, existing studies on plasmin inhibitor complex (PIC) and thrombin-antithrombin III complex (TAT) mostly apply the enzyme-linked immunosorbent assay (ELISA) method. The aim of this study is to establish the baseline of thrombolytic treatment for AIS patients; to monitor the fibrinolytic and coagulation system following alteplase administration; to ascertain the proper time point to predict intracerebral hemorrhage.

Methods: The method used to assess a patient's intravascular situation, namely chemiluminescence, was used to quantitatively assess the PIC, TAT, and thrombomodulin (TM). Immuno-turbidimetric was used to assess the concentration of D-dimer, fibrin/fibrinogen degradation products (FDP), and the Von Willebrand factor (vWF). The Clauss clotting method was used to assay the activated partial thromboplastin time (APTT), prothrombin time (PT) and FIB.

Results: PIC increased to its peak concentration at 3 hours post intravenous (IV) alteplase infusion and decreased by nearly 50% every 3 hours thereafter. After 24 hours, PIC returned to its normal range, while D-dimer and FDP decreased 3 hours later compared to PIC. PT and APTT exhibited no obvious change during the 24-hour period. TM also exhibited no changes during the treatment.

Conclusion: PIC decreased 3 hours earlier than D-dimer and FDP. The combined test of PIC, D-dimer, and fibrinogen can be used to monitor the fibrinolytic system after the IV alteplase infusion. The use of IV alteplase had no impact on the endothelium. Creating a patient's individual data curve could assist in the prediction of hemorrhagic transformation (HT) and a stroke occurring.

Keywords: D‐dimer; IV alteplase; acute ischemic stroke; plasmin‐a2 plasmin inhibitor complex; thrombin‐antithrombin complex.