Platelet-to-lymphocyte ratio at 24h after thrombolysis is a prognostic marker in acute ischemic stroke patients

Abstract Introduction: The role of Platelet-to-lymphocyte ratio (PLR) in outcomes of acute ischemic stroke, especially before and after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA), has not been elucidated. Thus, the aim of this study was to evaluate the effect of PLR before and after rtPA on clinical outcomes.Methods: A total of 582 consecutive patients who had acute ischemic stroke diagnosed and received intravenous thrombolysis with rtPA were included in this study. We collected demographics, vascular risk factors, previous history of drugs and other clinical information for all patients. Specifically, blood samples for PLR values were collected on admission and at 24 hours after stroke. Multivariate logistic regression analysis was used to assess the association between PLR with the risk of poor outcome (mRS≥3), death and hemorrhagic transformation (HT). Results: Of 582 patients, 191 (32.8%) had a poor outcome, 40 (6.9%) died and 82 (14.1%) had HT. After adjustment for potential confounders, multivariate logistic regression analysis showed that higher PLR at 24h after rtPA was independently associated with an increased risk of poor outcome (OR=1.004; 95% CI:1.001-1.007; P=0.009) and the occurrence of death (OR=1.009; 95% CI:1.004-1.013; P<0.001), but not associated with the risk of HT (OR=1.003; 95% CI:0.999-1.007; P=0.165). In addition, PLR on admission was not associated with the risk of poor outcome, death and HT (all P>0.05).Conclusions: We found that PLR at 24h after rtPA can predict the risk of poor outcome and death in acute ischemic stroke patients, but PLR on admission cannot.

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Delayed Stroke Treatment during COVID-19 Pandemic in China

10.1101/2020.11.17.20228122 ◽

2020 ◽

Author(s):

Shiyuan Gu ◽

Zhengze Dai ◽

Huachao Shen ◽

Yongjie Bai ◽

Xiaohao Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Intravenous Thrombolysis ◽

Multivariate Logistic Regression ◽

Delayed Treatment

ABSTRACTBackgroundSocial distance, quarantine, pathogen testing and other preventive strategies implemented during COVID-19 pandemic may negatively influence the management of acute stroke.ObjectiveThe current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of acute stroke in China.MethodsThis study included patients with acute stroke admitted in two hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 epidemic outbreak (January 31, 2020, as officially announced by Chinese government) were compared for pre- (measured as onset-to-door time) and post-hospital delay (measured as door-to-needle time). The influence factors for delayed treatment (indicated as onset-to-needle time >4.5 hours) were analyzed with multivariate logistic regression analysis.ResultsOnset-to-door time increased from 202 min (IQR 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (P=0.001). Door-to-needle time increased from 50min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (P=0.048). The proportion of patients with intravenous thrombolysis in those with acute ischemic stroke was decreased significantly after the pandemic (15.4% vs 20.1%; P=0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms and transported by other means than ambulance were associated with delayed treatment.ConclusionsCOVID-19 pandemic has remarkable impacts on the management of acute ischemic stroke. Both pre- and post-hospital delays were prolonged significantly, and proportion of patient arrived within the 4.5-hour time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.

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Abstract TP204: Neutrophil-to-lymphocyte Ratio Predicts Short-term Functional Outcome in Acute Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.tp204 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Meyung Kug Kim ◽

Yoon Suk Ha ◽

Bong Goo Yoo

Keyword(s):

Regression Analysis ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Short Term ◽

Nihss Score ◽

Poor Outcome ◽

The Poor

Introduction: As indicators of the systemic inflammatory response, the neutrophil-to-lymphocyte ratio (NLR) have been proposed to predict the clinical outcome in cardiovascular disease, diabetes, and various malignancies. We assessed the significance of NLR as a predictor of the outcome in patients with acute ischemic stroke. Methods: We retrospectively analyzed the clinical characteristics, laboratory parameters, and NLR in 356 consecutive patients (62.2% men, mean age 65.8±13.0 years) within 3 days after the onset of acute ischemic stroke between July 2012 and March 2015. The NLR was calculated from the differential counts by dividing the neutrophil number by the lymphocyte number at the time of admission. All subjects were divided into four groups according to quartiles of the NLR. Outcomes were measured as 3-month modified Rankin scale (mRS) score. A good functional outcome was defined as a mRS of 0-2 points, whereas a poor outcome was defined as a mRS of >2 points. Multivariate logistic regression analysis was used to assess association among the clinical, inflammatory and serological parameters including NLR and mRS scores. Results: The frequency of atrial fibrillation, heart failure, hypertension, and diabetes, the NIHSS score at admission, and the level of hs-CRP, D-dimer and the NLR were each significantly higher in the poor outcome group (p < 0.05). The cut-off values of NLR and NIHSS score at admission for prediction of the poor outcome were 2.135 (sensitivity 0.864 and specificity 0.533) and 3.5 (sensitivity 0.862 and specificity 0.787), respectively. In age-adjusted analysis, the NLR were significantly correlated with 3-month mRS score (partial r = 0.329, p < 0.001) and NIHSS score at discharge (partial r = 0.301, p < 0.001). Multivariate logistic regression analysis demonstrated that age of ≥65 (OR, 10.2; 95% CI, 3.31-31.21, p < 0.001), presence of diabetes mellitus (OR, 3.3; 95% CI, 1.36-8.12, p = 0.008), NIHSS score of ≥4 (OR, 26.4 95% CI, 9.81-71.15, p < 0.001), NLR of ≥2.135 (OR, 9.2; 95% CI, 3.18-26.4, p < 0.001) were independently associated with poor functional outcome. Conclusion: The NLR is a useful marker for short-term functional outcome in acute ischemic stroke. The NLR may have a role in risk stratification for predicting poor outcome.

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Abstract TP176: Risk Factors and Clinical Significances of the Quantitative CTA Vascular Calcification in Ischemic Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.tp176 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takashi Shimoyama ◽

Sibaji Gaj ◽

Kunio Nakamura ◽

Shivakrishna Kovi ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Vascular Calcification ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Stroke Patients ◽

Age Category

Background and Purpose: Intracranial arterial calcification is a marker of atherosclerosis burden in the general population. The aim of the study is to investigate risk factor profiles of vascular calcification in ischemic stroke patients. Methods: We identified ischemic stroke patients who underwent complete CTA from a prospective single-hospital stroke registry in 2018. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Severe vascular calcification was defined as patients in the upper quartile calcification volume. The prevalence of severe vascular calcification and mean calcification volume were investigated by age category (<60 years, 60-70 years, 70-80 years, 80 years ≥). The relation between each potential risk factors and severe vascular calcification was assessed using the multivariate logistic regression analysis adjusted for age, sex, NIHSS score, and TOAST stroke subtypes. Results: Of the 558 consecutive acute ischemic stroke patients, 388 patients (212 males; mean age 66.6±14.2 years) met inclusion and with quantitative CTA calcification. The prevalence of severe vascular calcification (CTA calcification volume> 812 mm 3 ) increased with increasing age category (<60 years: 6.8% (7/103), 60-70 years: 15.7% (18/115), 70-80 years: 39.6% (38/105), 80 years ≥: 45.9% (34/74), P<0.001 for χ 2 test). Over age 80 years subsets had significantly higher mean calcification volume with 1213 mm 3 than other age category (<60 years: 225 mm 3 , P<0.001; 60-70 years: 462 mm 3 , P<0.001; 70-79 years: 817 mm 3 , P=0.020 for t-test). In the multivariate logistic regression analysis, age (OR 1.096, 95% CI 1.066-1.128, P<0.001), smoking (OR 3.430, 95% CI 1.833-6.419, P<0.001), and large artery atherosclerosis (LAA) (OR 4.260, 95% CI 1.963-9.247, P<0.001) were independently associated with severe vascular calcification. Conclusion: In the quantitative CTA analysis of calcification volume, older age and smoking were high risk for severe atherosclerotic calcium burden in ischemic stroke patients. Moreover, severe vascular calcification may differentiate LAA from other stroke etiology.

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Abstract 3994: Obese Patients Receiving Intravenous Thrombolysis in Acute Ischemic Stroke Have lower Rates of Intracerebral hemorrhage and Mortality

Stroke ◽

10.1161/str.43.suppl_1.a3994 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Ameer Hassan ◽

Mikayel Grigoryan ◽

Saqib Chaudhry ◽

Adnan Qureshi

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Intravenous Thrombolysis ◽

International Classification Of Diseases ◽

The United States ◽

Obese Patients ◽

Stroke Patients ◽

Intravenous Tissue Plasminogen Activator ◽

Classification Of Diseases

Background: The current recommended dose of intravenous tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg is fixed at 90 mg and thus obese patients receive less than the recommend 0.9mg/kg dosage. We hypothesized that obese patients receive a lower dose of thrombolytics and they will have a lower rates of intracerebral hemorrhages (ICH), but lower rates of clinical benefit from IV rt-PA. Objective: To determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data were obtained from all states within the United States that contributed to the Nationwide Inpatient Sample. All patients admitted to US hospitals between 2002 and 2009 with a primary discharge diagnosis of stroke treated with IV thrombolysis (identified by the International Classification of Diseases, Ninth Revision procedure codes) were included. We analyzed whether the presence of obesity was associated with clinical outcome and ICH with multivariate logistic regression analysis after adjusting for potential confounders. Results: Of the 84,727 patients with ischemic stroke treated with IV rt-PA, 5,437 (6.4%) had concurrent obesity. The ICH rates between obese and non-obese patients was 4.3% versus 6.1% (p=0.005). After adjusting for age, sex, hypertension, diabetes mellitus, renal failure, hospital teaching status, and ICH, the presence of obesity was not associated with increased rates of self-care (odds ratio [OR] 0.929, 95% confidence interval [CI] 0.815-1.063, p=0.27), but was associated with decreased rates of mortality (OR 0.78, 95% CI 0.61 - 0.94, p=0.045) at discharge. Conclusion: Obese patients undergoing IV t-PA treatment for acute ischemic stroke appear to have lower rates of ICHs and mortality presumably due to lower weight adjusted thrombolytic dose.

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Abstract WMP59: A Simple Clinical And MRI Score To Assess A Risk For Development Of Malignant Middle Cerebral Artery Infarction In Large Hemispheric Acute Ischemic Stroke.

Stroke ◽

10.1161/str.44.suppl_1.awmp59 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Takashi Shimoyama ◽

Junichi Uemura ◽

Shinji Yamashita ◽

Kensaku Shibazaki ◽

Takeshi Inoue ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Surgical Decompression ◽

Multivariate Logistic Regression ◽

Malignant Mca Infarction ◽

Mri Score

Background: Early surgical decompression has reduced case fatality and improved functional outcome in patients with malignant middle cerebral artery (MCA) infarction. Therefore, identifying patients who will develop life-threatening brain edema is imperative. The aim of the present study was to devise a simple clinical and MRI score for assessing a risk for malignant course in patients with large MCA infarction within 48 hr after admission. Methods: Patients with MCA infarction ≥2/3 of the territory and proximal vessel occlusion (ICA or M1) within 24 hr of onset were retrospectively studied. We defined malignant MCA infarction as follows: (1) secondary decline of consciousness ≥1 point on the NIHSS with midline shift ≥5 mm at the level of septum pellucidum at follow-up CT or MRI; (2) anisocoria or death attributable to herniation. We created a simple score to determine a risk for development of malignant MCA infarction using factors selected by multivariate logistic regression analysis. Results: Subjects comprised 119 patients (55 men, median age 78.0 years). Fifty-seven patients (47.9%) developed malignant MCA infarction within 48hr after admission. Multivariate logistic regression analysis revealed the following independent factors associated with malignant MCA infarction: involvement of ACA territory [odds ratio (OR), 15.33; 95% confidence interval (CI), 0.39-59.77; P<0·001], glucose value >145mg/dl [OR, 6.68; 95% CI, 2.19-20.42; P=0.001], and M1 vessel sign on T2*-gradient echo imaging [OR, 5.82; 95% CI, 1.71-19.78; P=0.005]. Those three variables were selected for use in the score, with involvement of ACA territory as 2 points, glucose value >145 mg/dl as 1 point, and M1 vessel sign as 1 point. Frequencies of patients developing malignant MCA infarction for each score were as follows: score 0, 10.0%; score 1, 23.5%; score 2, 71.4%; score 3-4, 96.3%. The C statistic for the score was 0.875 (95%CI, 0.810-0·940, P<0.001). Conclusion: Our simple clinical and MRI score reliably assessed a risk for development of malignant MCA infarction in large hemispheric acute ischemic stroke, and it should support clinical decision making in early surgical decompression.

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Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015889 ◽

2020 ◽

Vol 13 (1) ◽

pp. 14-18 ◽

Cited By ~ 5

Author(s):

Noel van Horn ◽

Helge Kniep ◽

Hannes Leischner ◽

Rosalie McDonough ◽

Milani Deb-Chatterji ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Logistic Regression Analysis ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Clinical Outcome ◽

Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

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Clinical significance of stroke nurse in patients with acute ischemic stroke receiving intravenous thrombolysis

BMC Neurology ◽

10.1186/s12883-021-02375-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhao-Han Xu ◽

Qi-Wen Deng ◽

Qian Zhai ◽

Qing Zhang ◽

Zhen-Jie Wang ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Mediation Analysis ◽

Multivariate Logistic Regression Analysis ◽

Specific Effect ◽

Intravenous Thrombolysis ◽

Multivariate Logistic Regression ◽

Significant Difference ◽

Before And After ◽

Baseline Characteristics

Abstract Background Reports have proven that shorter door-to-needle time (DTN time) indicates better outcomes in AIS patients received intravenous thrombolysis. Efforts have been made by hospitals and centers to minimize DTN time in many ways including introducing a stroke nurse. However, there are few studies to discuss the specific effect of stroke nurse on patients’ prognosis. This study aimed to compare consecutive AIS patients before and after the intervention to analyze the effect of stroke nurse on clinical outcome of AIS patients. Methods In this retrospective study, we observed 1003 patients from November 2016 to December 2020 dividing in two groups, collected and analyzed AIS patients’ medical history, clinical assessment information, important timelines, 90 mRS score, etc. Comparative analysis and mediation analysis were also used in this study. Results A total of 418 patients was included in this study, and 199 patients were enrolled in the stroke nurse group and 219 was in the preintervention group. Baseline characteristics of patients showed no significant difference except there seems more patients with previous ischemic stroke history in the group of stroke nurse. (p = 0.008). The median DTN time significantly decreased in the stroke nurse group (25 min versus 36 min, p < 0.001) and multivariate logistic regression analysis showed the 90-day mRS clinical outcome significantly improved in the stroke nurse group (p = 0.001). Mediation analysis indicated the reduction of DTN time plays a partial role on the 90 days mRS score and the stroke nurse has some direct effect on the improvement of clinical outcome (p = 0.006). Conclusions The introduction of stroke nurse is beneficial to clinical outcome of AIS patients and can be use of reference in other hospitals or centers.

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Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

International Journal of Stroke ◽

10.1177/1747493020923234 ◽

2020 ◽

Vol 15 (5) ◽

pp. 540-554 ◽

Cited By ~ 39

Author(s):

Adnan I Qureshi ◽

Foad Abd-Allah ◽

Fahmi Al-Senani ◽

Emrah Aytac ◽

Afshin Borhani-Haghighi ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Current Knowledge ◽

Intravenous Thrombolysis ◽

Adult Patients ◽

World Health ◽

Stroke Patients ◽

International Panel ◽

Health Organization ◽

Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

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Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211021182 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110211

Author(s):

Georgios Magoufis ◽

Apostolos Safouris ◽

Guy Raphaeli ◽

Odysseas Kargiotis ◽

Klearchos Psychogios ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Time Windows ◽

Intravenous Thrombolysis ◽

Inclusion Criteria ◽

Stroke Patients ◽

Treatment Algorithms ◽

Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

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Incorporation of α2-Plasmin Inhibitor into Fibrin Clots and Its Association with the Clinical Outcome of Acute Ischemic Stroke Patients

Biomolecules ◽

10.3390/biom11030347 ◽

2021 ◽

Vol 11 (3) ◽

pp. 347

Author(s):

Zsuzsa Bagoly ◽

Barbara Baráth ◽

Rita Orbán-Kálmándi ◽

István Szegedi ◽

Réka Bogáti ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Intravenous Thrombolysis ◽

Fibrin Clot ◽

Clot Lysis ◽

Stroke Patients ◽

Plasmin Inhibitor ◽

Fibrin Clots

Cross-linking of α2-plasmin inhibitor (α2-PI) to fibrin by activated factor XIII (FXIIIa) is essential for the inhibition of fibrinolysis. Little is known about the factors modifying α2-PI incorporation into the fibrin clot and whether the extent of incorporation has clinical consequences. Herein we calculated the extent of α2-PI incorporation by measuring α2-PI antigen levels from plasma and serum obtained after clotting the plasma by thrombin and Ca2+. The modifying effect of FXIII was studied by spiking of FXIII-A-deficient plasma with purified plasma FXIII. Fibrinogen, FXIII, α2-PI incorporation, in vitro clot-lysis, soluble fibroblast activation protein and α2-PI p.Arg6Trp polymorphism were measured from samples of 57 acute ischemic stroke patients obtained before thrombolysis and of 26 healthy controls. Increasing FXIII levels even at levels above the upper limit of normal increased α2-PI incorporation into the fibrin clot. α2-PI incorporation of controls and patients with good outcomes did not differ significantly (49.4 ± 4.6% vs. 47.4 ± 6.7%, p = 1.000), however it was significantly lower in patients suffering post-lysis intracranial hemorrhage (37.3 ± 14.0%, p = 0.004). In conclusion, increased FXIII levels resulted in elevated incorporation of α2-PI into fibrin clots. In stroke patients undergoing intravenous thrombolysis treatment, α2-PI incorporation shows an association with the outcome of therapy, particularly with thrombolysis-associated intracranial hemorrhage.

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