Useless. The idea is to prevent this complication, why the fuck aren't you doing research on that? Describing a problem with no solution helps no one.
Change of Serum Biomarkers to Post-Thrombolytic Symptomatic Intracranial Hemorrhage in Stroke
Yu Cui1, 
Xin-Hong Wang1, Yong Zhao2, Shao-Yuan Chen3, Bao-Ying Sheng4, 
Li-Hua Wang5 and 
Hui-Sheng Chen1*- 1Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
- 2Department of Neurology, Haicheng Hospital of Traditional Chinese Medicine, Haicheng, China
- 3Department of Neurology, Chinese People's Liberation Army 321 Hospital, Baicheng, China
- 4Department of Neurology, Jiamusi University First Affiliated Hospital, Jiamusi, China
- 5Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
Background: Symptomatic intracranial hemorrhage (sICH) is a terrible complication after intravenous alteplase in stroke, and numerous biomarkers have been investigated. However, the change of biomarkers to sICH has not been well determined.
Aim: To investigate the association between the change of biomarkers and sICH.
Methods: This is a prospective cohort study, and patients with sICH within 24 h after thrombolysis were enrolled, while patients without sICH were matched by propensity score matching with a ratio of 1:1. The blood samples were collected before and 24 h after intravenous thrombolysis (IVT), and preset 49 serum biomarkers were measured by microarray analysis. Protein function enrichment analyses were performed to detect the association between the change of biomarkers and sICH.
Results: Of consecutive 358 patients, 7 patients with sICH in 24 h were assigned to the sICH group, while 7 matched patients without any ICH were assigned to the non-sICH group. A total of 9 biomarkers were found to significantly change before vs. after thrombolysis between groups, including increased biomarkers, such as brain-derived neurotrophic factor, C-C motif chemokine ligand (CCL)-24, interleukin (IL)-6, IL-10, IL-18, and vascular endothelial growth factor, and decreased biomarkers, such as CCL-11, intercellular adhesion molecule-1, and IL-7.
Conclusions: This is the first study to identify changes in serum biomarkers in patients with sICH after IVT, and found that 6 neuroinflammatory and 3 neuroprotective biomarkers may be associated with brain injury following post-thrombolytic sICH.
Clinical Trial Registration: https://www.clinicaltrials.gov, identifier: NCT02854592.
Introduction
Intravenous alteplase is the main effective treatment for acute ischemic stroke (AIS) within 4.5 h after the onset of symptoms (1). Symptomatic intracranial hemorrhage (sICH) is a rare but severe complication after thrombolysis that is closely related to disability and death (2).
Mountains of studies have investigated predictors for post-thrombolytic sICH in stroke, such as clinical, radiological, and laboratory factors (3–5). Although several biomarkers were found to be associated with post-thrombolytic hemorrhagic transformation (6–11), these biomarkers were only detected at admission. To date, however, only one study investigated the change of serum biomarkers after post-thrombolytic sICH (12). Given that changes in biomarkers before and after sICH maybe reflect the secondary brain injury of sICH, the issue needed to be further investigated.
In the INtravenous Thrombolysis REgistry for Chinese Ischemic Stroke within 4.5 h of onset (INTRECIS) (13), 5 centers were pre-designed to consecutively collect blood samples before and 24 h after thrombolysis. In this study, we tried to identify what serum biomarkers change significantly before thrombolysis vs. after sICH, compared with patients without any ICH and investigated the potential interactions by microarray analysis on 49 preset biomarkers.
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