PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients
Abstract Objective Thrombolysis by recombinant tissue plasminogen activator (rt‐PA) is the main pharmacological therapy in acute ischemic stroke (IS); however, it is only effective in a subset of patients. Here we aimed to investigate the role of plasminogen activator inhibitor‐1 (PAI‐1), an effecti...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-11-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.50923 |
| _version_ | 1830373769096462336 |
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| author | István Szegedi Attila Nagy Edina G. Székely Katalin R. Czuriga‐Kovács Ferenc Sarkady Levente I. Lánczi Ervin Berényi László Csiba Zsuzsa Bagoly |
| author_facet | István Szegedi Attila Nagy Edina G. Székely Katalin R. Czuriga‐Kovács Ferenc Sarkady Levente I. Lánczi Ervin Berényi László Csiba Zsuzsa Bagoly |
| author_sort | István Szegedi |
| collection | DOAJ |
| description | Abstract Objective Thrombolysis by recombinant tissue plasminogen activator (rt‐PA) is the main pharmacological therapy in acute ischemic stroke (IS); however, it is only effective in a subset of patients. Here we aimed to investigate the role of plasminogen activator inhibitor‐1 (PAI‐1), an effective inhibitor of t‐PA, and its major polymorphism (PAI‐1 4G/5G) in therapy outcome. Methods Study population included 131 consecutive IS patients who all underwent thrombolysis. Blood samples were taken on admission, 1 and 24 h after rt‐PA infusion. PAI‐1 activity and antigen levels were measured from all blood samples and the PAI‐1 4G/5G polymorphism was determined. Clinical data including NIHSS were registered on admission and day 1. ASPECTS was assessed using CT images taken before and 24 h after thrombolysis. Intracranial hemorrhage (ICH) was classified according to ECASS II. Long‐term outcome was defined 90 days post‐event by the modified Rankin Scale (mRS). Results PAI‐1 activity levels dropped transiently after thrombolysis, while PAI‐1 antigen levels remained unchanged. PAI‐1 4G/5G polymorphism had no effect on PAI‐1 levels and did not influence stroke severity. PAI‐1 activity/antigen levels as measured on admission were significantly elevated in patients with worse 24 h ASPECTS (<7). Logistic regression analysis including age, sex, NIHSS on admission, BMI, history of arterial hypertension, and hyperlipidemia conferred a significant, independent risk for developing ICH in the presence of 5G/5G genotype (OR:4.75, 95%CI:1.18–19.06). PAI‐1 levels and PAI‐1 4G/5G polymorphism had no influence on long‐term outcomes. Interpretation PAI‐1 5G/5G genotype is associated with a significant risk for developing ICH in post‐lysis stroke patients. |
| first_indexed | 2024-12-20T07:25:40Z |
| format | Article |
| id | doaj.art-9d65b22216174340bf430239fae966ab |
| institution | Directory Open Access Journal |
| issn | 2328-9503 |
| language | English |
| last_indexed | 2024-12-20T07:25:40Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj.art-9d65b22216174340bf430239fae966ab2022-12-21T19:48:33ZengWileyAnnals of Clinical and Translational Neurology2328-95032019-11-016112240225010.1002/acn3.50923PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patientsIstván Szegedi0Attila Nagy1Edina G. Székely2Katalin R. Czuriga‐Kovács3Ferenc Sarkady4Levente I. Lánczi5Ervin Berényi6László Csiba7Zsuzsa Bagoly8Faculty of Medicine Department of Neurology Doctoral School of Neuroscience University of Debrecen 22 Móricz Zsigmond krt. Debrecen 4032HungaryFaculty of Public Health Department of Preventive Medicine University of Debrecen 26 Kassai út Debrecen 4032HungaryFaculty of Medicine Department of Laboratory Medicine Division of Clinical Laboratory Sciences University of Debrecen 98 Nagyerdei krt. Debrecen 4032HungaryFaculty of Medicine Department of Neurology Doctoral School of Neuroscience University of Debrecen 22 Móricz Zsigmond krt. Debrecen 4032HungaryFaculty of Medicine Department of Laboratory Medicine Division of Clinical Laboratory Sciences University of Debrecen 98 Nagyerdei krt. Debrecen 4032HungaryFaculty of Medicine Department of Radiology University of Debrecen 98 Nagyerdei krt. Debrecen 4032HungaryFaculty of Medicine Department of Radiology University of Debrecen 98 Nagyerdei krt. Debrecen 4032HungaryFaculty of Medicine Department of Neurology Doctoral School of Neuroscience University of Debrecen 22 Móricz Zsigmond krt. Debrecen 4032HungaryFaculty of Medicine Department of Laboratory Medicine Division of Clinical Laboratory Sciences University of Debrecen 98 Nagyerdei krt. Debrecen 4032HungaryAbstract Objective Thrombolysis by recombinant tissue plasminogen activator (rt‐PA) is the main pharmacological therapy in acute ischemic stroke (IS); however, it is only effective in a subset of patients. Here we aimed to investigate the role of plasminogen activator inhibitor‐1 (PAI‐1), an effective inhibitor of t‐PA, and its major polymorphism (PAI‐1 4G/5G) in therapy outcome. Methods Study population included 131 consecutive IS patients who all underwent thrombolysis. Blood samples were taken on admission, 1 and 24 h after rt‐PA infusion. PAI‐1 activity and antigen levels were measured from all blood samples and the PAI‐1 4G/5G polymorphism was determined. Clinical data including NIHSS were registered on admission and day 1. ASPECTS was assessed using CT images taken before and 24 h after thrombolysis. Intracranial hemorrhage (ICH) was classified according to ECASS II. Long‐term outcome was defined 90 days post‐event by the modified Rankin Scale (mRS). Results PAI‐1 activity levels dropped transiently after thrombolysis, while PAI‐1 antigen levels remained unchanged. PAI‐1 4G/5G polymorphism had no effect on PAI‐1 levels and did not influence stroke severity. PAI‐1 activity/antigen levels as measured on admission were significantly elevated in patients with worse 24 h ASPECTS (<7). Logistic regression analysis including age, sex, NIHSS on admission, BMI, history of arterial hypertension, and hyperlipidemia conferred a significant, independent risk for developing ICH in the presence of 5G/5G genotype (OR:4.75, 95%CI:1.18–19.06). PAI‐1 levels and PAI‐1 4G/5G polymorphism had no influence on long‐term outcomes. Interpretation PAI‐1 5G/5G genotype is associated with a significant risk for developing ICH in post‐lysis stroke patients.https://doi.org/10.1002/acn3.50923 |
| spellingShingle | István Szegedi Attila Nagy Edina G. Székely Katalin R. Czuriga‐Kovács Ferenc Sarkady Levente I. Lánczi Ervin Berényi László Csiba Zsuzsa Bagoly PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients Annals of Clinical and Translational Neurology |
| title | PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients |
| title_full | PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients |
| title_fullStr | PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients |
| title_full_unstemmed | PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients |
| title_short | PAI‐1 5G/5G genotype is an independent risk of intracranial hemorrhage in post‐lysis stroke patients |
| title_sort | pai 1 5g 5g genotype is an independent risk of intracranial hemorrhage in post lysis stroke patients |
| url | https://doi.org/10.1002/acn3.50923 |
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