Clinical diabetes impact factor
Study cohort included consecutive AIS patients clinical diabetes impact factor i. Blood samples taken on admission, immediately after and 24 h after therapy were analyzed for FXIII activity and antigen levels. Val34Leu, p.
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Long-term functional outcome was defined at 3 months post-event by the modified Rankin scale. FXIII levels showed a gradual decrease immediately after thrombolysis and 24 h later, which was not related to therapy-associated bleeding. In a multiple logistic regression model, a FXIII level in the lowest quartile 24 h post-lysis proved to be an independent predictor of mortality by 14 days post-event OR In conclusion, our findings indicate that FXIII levels 24 h after thrombolysis might help to identify patients at increased risk for short-term mortality.
Introduction Acute ischemic stroke AIS is a leading cause of death or disability in all developed countries 1. Today, the most effective pharmacological therapy to improve functional outcomes is the lysis of thrombi using recombinant tissue plasminogen activator rtPA within 4.
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Although this intervention has been used for many decades, little is known why in some patients thrombolysis is less efficient and which are the factors promoting non-desirable side effects in others. In a subset of patients thrombolytic therapy is inefficient due to the failure of recanalization of the closed vessel and no clinical improvement is observed 3. In most cases, these complications cannot be foreseen at the initiation of therapy and their occurrence remains unexplained.
It is plausible that effectiveness as well as adverse effects of the thrombolytic agent could depend on hemostatic and fibrinolytic factors influencing the structure of thrombi and the susceptibility to lysis. With the introduction of mechanical thrombectomy in the management of acute stroke care, today it is becoming important to identify patients who are at risk of worse thrombolysis outcomes and would benefit from alternative treatments 4.
The active form FXIIIa plays a crucial role in protecting the clot against prompt fibrinolytic degradation, which is achieved by at least three major ways.
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First, FXIIIa cross-links α2-plasmin inhibitor α2-PI and perhaps other plasma components to fibrin, which effectively hinders its proteolytic degradation by plasmin.
Second, FXIIIa cross-links fibrin α-chains into a high molecular weight α-polymers, which most likely has a direct effect on the susceptibility of fibrin clot to lysis.
Third, cross-linking of fibrin by FXIIIa decreases the binding of plasminogen to fibrin, and consequently, decreases plasminogen activation by tPA 9. On the other hand, deficiency of FXIII leads to a life-long bleeding disorder and in many cases severe or fatal intracranial hemorrhage is a prominent feature of the disease TyrPhe, p.
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- Go to: References 1.
ValIle, p. His95Arg and c.
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Val34Leu with the risk of thrombotic diseases has been intensively investigated 5clinical diabetes impact factor9. Results Study population Baseline characteristics of patients and stroke outcomes are summarized in Table 1. A total of consecutive AIS patients undergoing thrombolysis were included in the study.
Mean age was Average time from symptom onset to treatment with rtPA was less than 3 h in the cohort and the duration of thrombolysis was approximately one hour for each patient. In case of 7 patients intravenous thrombolytic therapy was supplemented with intraarterial thrombolysis according to the standard protocol; the final dose of rtPA and the duration of thrombolysis was not significantly different for these patients as compared to the rest of the study group.
Table 1 Baseline characteristics and outcomes of patients.