Plasmin Generation Potential and Recanalization in Acute Ischaemic Stroke; an Observational Cohort Study of Stroke Biobank Samples

Thomas Lillicrap, Charithani B. Keragala, Dominik F. Draxler, Jilly Chan, Heidi Ho, Stevi Harman, Be'eri Niego, Elizabeth Holliday, Christopher R. Levi, Carlos Garcia-Esperon, Neil Spratt, Prajwal Gyawali, Andrew Bivard, Mark W. Parsons, Joan Montaner, Alejandro Bustamante, Israel Fernandez Cadenas, Geoffrey Cloud, Jane M. Maguire, Lisa LinczTimothy Kleinig, John Attia, Simon Koblar, Monica Anne Hamilton-Bruce, Philip Choi, Bradford B. Worrall, Robert L. Medcalf

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Rationale: More than half of patients who receive thrombolysis for acute ischaemic stroke fail to recanalize. Elucidating biological factors which predict recanalization could identify therapeutic targets for increasing thrombolysis success. Hypothesis: We hypothesize that individual patient plasmin potential, as measured by in vitro response to recombinant tissue-type plasminogen activator (rt-PA), is a biomarker of rt-PA response, and that patients with greater plasmin response are more likely to recanalize early. Methods: This study will use historical samples from the Barcelona Stroke Thrombolysis Biobank, comprised of 350 pre-thrombolysis plasma samples from ischaemic stroke patients who received serial transcranial-Doppler (TCD) measurements before and after thrombolysis. The plasmin potential of each patient will be measured using the level of plasmin-antiplasmin complex (PAP) generated after in-vitro addition of rt-PA. Levels of antiplasmin, plasminogen, t-PA activity, and PAI-1 activity will also be determined. Association between plasmin potential variables and time to recanalization [assessed on serial TCD using the thrombolysis in brain ischemia (TIBI) score] will be assessed using Cox proportional hazards models, adjusted for potential confounders. Outcomes: The primary outcome will be time to recanalization detected by TCD (defined as TIBI ≥4). Secondary outcomes will be recanalization within 6-h and recanalization and/or haemorrhagic transformation at 24-h. This analysis will utilize an expanded cohort including ~120 patients from the Targeting Optimal Thrombolysis Outcomes (TOTO) study. Discussion: If association between proteolytic response to rt-PA and recanalization is confirmed, future clinical treatment may customize thrombolytic therapy to maximize outcomes and minimize adverse effects for individual patients.

Original languageEnglish
Article number589628
Number of pages8
JournalFrontiers in Neurology
Volume11
DOIs
Publication statusPublished - 3 Nov 2020

Keywords

  • acute stroke therapy
  • fibrinolysis
  • plasmin
  • recanalization
  • rtPA
  • stroke
  • thrombolysis

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