Lillicrap, Thomas and Keragala, Charithani B. and Draxler, Dominik F. and Chan, Jilly and Ho, Heidi and Harman, Stevi and Niego, Be’eri and Holliday, Elizabeth and Levi, Christopher R. and Garcia-Esperon, Carlos and Spratt, Neil and Gyawali, Prajwal 
ORCID: https://orcid.org/0000-0003-0975-5576 and Bivard, Andrew and Parsons, Mark W. and Montaner, Joan and Bustamante, Alejandro and Cadenas, Israel Fernandez and Cloud, Geoffrey and Maguire, Jane M. and Lincz, Lisa and Kleinig, Timothy and Attia, John and Koblar, Simon and Hamilton-Bruce, Monica Anne and Choi, Philip and Worrall, Bradford B. and Medcalf, Robert L.
(2020)
Plasmin Generation Potential and Recanalization in Acute Ischaemic Stroke; an Observational Cohort Study of Stroke Biobank Samples.
Frontiers in Neurology, 11:589628.
pp. 1-4.
ISSN 1664-2295
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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.
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