Alterations of Hemostatic Molecular Markers During Acute Large Vessel Occlusion Stroke

Abstract

Background This study aimed to investigate regional levels of TAT (thrombin‐antithrombin complex), PIC (plasmin‐α2 plasmin inhibitor complex), t‐PAIC (tissue plasminogen activator‐plasminogen activator inhibitor complex), sTM (soluble thrombomodulin), and D‐dimer, along with their associations with clinical and procedural characteristics in patients with acute ischemic stroke undergoing endovascular thrombectomy. Methods and Results We retrospectively analyzed 166 consecutive patients with acute ischemic stroke (62±11.54 years of age, 34.3% women) using prospectively maintained clinical databases and blood samples from local ischemic (proximal to thrombus) and systemic (femoral artery, self‐control) arterial compartments. Levels of TAT, PIC, t‐PAIC, and D‐dimer were significantly elevated, whereas sTM was significantly reduced, in local ischemic regions compared with their systemic levels. Each 1‐unit increase in ischemic TAT (adjusted odds ratio [aOR], 1.086 [95% CI, 1.03–1.145]; P=0.002; area under the curve [AUC], 0.833) and PIC (aOR, 1.337 [95% CI, 1.087–1.644]; P=0.006; AUC, 0.771) correlated significantly with higher symptomatic intracranial hemorrhage risk. Additionally, each 1‐unit increase in ischemic TAT (aOR, 1.076 [95% CI, 1.016–1.139]; P=0.013; AUC, 0.797), PIC (aOR, 1.554 [95% CI, 1.194–2.022]; P=0.001; AUC, 0.798), and sTM (aOR, 0.769 [95% CI, 0.615–0.961]; P=0.021; AUC, 0.756) was significantly associated with an increased risk of an unfavorable 90‐day outcome (modified Rankin scale of 3–6). These hemostatic molecules, individually or combined, significantly improved the predictive power of conventional risk factors, as evidenced by significant increases in net reclassification improvement and integrated discrimination improvement (all P<0.01). Conclusions We observed a hyperactive state of the coagulation‐fibrinolysis system within the local ischemic region during hyperacute stroke. Rapid automated measurement of hemostatic molecular markers, particularly TAT, PIC, and sTM, during intra‐arterial procedures may provide additional information for stroke risk stratification and therapeutic decision‐making, and warrants further investigation.

Keywords

• acute ischemic stroke
• coagulation
• endovascular thrombectomy
• fibrinolysis
• outcome