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ADAMTS13 activity is associated with early neurological improvement in acute ischemic stroke patients treated with intravenous thrombolysis

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Abstract

Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.

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Author information

Author notes

  1. Anne-Sophie Putzer, Hans Worthmann, Karin Weissenborn, and Ramona Schuppner have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Hannover Medical School, 30625, Hannover, Germany

    Anne-Sophie Putzer, Hans Worthmann, Gerrit M. Grosse, Meike Dirks, Karin Weissenborn & Ramona Schuppner

  2. Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625, Hannover, Germany

    Friedrich Goetz

  3. Department of Clinical Pharmacology, Otto-Guericke-University of Magdeburg, University Hospital, 39106, Magdeburg, Germany

    Jens Martens-Lobenhoffer & Stefanie M. Bode-Böger

  4. Medical Clinic V, Academic Teaching Hospital Braunschweig, 38118, Brunswick, Germany

    Jan T. Kielstein

  5. Department of Clinical Chemistry, Hannover Medical School, 30625, Hannover, Germany

    Ralf Lichtinghagen

  6. Medilys Laboratory, Asklepios Klinik Altona, 22763, Hamburg, Germany

    Ulrich Budde

Authors
  1. Anne-Sophie Putzer
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  2. Hans Worthmann
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  3. Gerrit M. Grosse
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Contributions

Conceptualization: HW, KW and RS; methodology RL; validation HW, FG and RS; formal analysis A-SP, HW, GMG and RS; investigation: A-SP, HW, GMG, FG, MD, JTK, JM-L, SMB-B, UB and RS; data curation: A-SP, HW and RS; writing—original draft preparation, A-SP, HW and RS; writing—review and editing, GMG, FG, JM-L, MD, SMB-B and KW visualization, A-SP and RS; supervision, HW, GMG, KW and RS.

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Correspondence to Ramona Schuppner.

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Putzer, AS., Worthmann, H., Grosse, G.M. et al. ADAMTS13 activity is associated with early neurological improvement in acute ischemic stroke patients treated with intravenous thrombolysis. J Thromb Thrombolysis 49, 67–74 (2020). https://doi.org/10.1007/s11239-019-01941-7

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