Emergency Admission Plasma D-Dimer and Prothrombin Activity: Novel Predictors for Clinical Outcomes After Thrombectomy in Acute Ischemic Stroke With Large Artery Occlusion

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-02-13 DOI:10.1111/cns.70267

Shandong Jiang, Peizheng Guo, Linxin Cai, Cong Qian, Jun Yu, Liang Xu, Xu Li, Xianyi Chen, Fang Bing, Yuan Yuan, Zhongju Tan, Jing Xu, Jianru Li

{"title":"Emergency Admission Plasma D-Dimer and Prothrombin Activity: Novel Predictors for Clinical Outcomes After Thrombectomy in Acute Ischemic Stroke With Large Artery Occlusion","authors":"Shandong Jiang, Peizheng Guo, Linxin Cai, Cong Qian, Jun Yu, Liang Xu, Xu Li, Xianyi Chen, Fang Bing, Yuan Yuan, Zhongju Tan, Jing Xu, Jianru Li","doi":"10.1111/cns.70267","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The coagulation system is intrinsically linked to pathological mechanisms and progression of ischemic stroke. However, the role of preoperative coagulation function in determining the functional outcomes of acute ischemic stroke patients following large artery occlusion (AIS-LVO) has not been extensively evaluated in peer-reviewed literature.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We utilized logistic regression analyses, complemented by the construction of receiver operating characteristic (ROC) curves, to identify significant predictive factors for poor prognosis following endovascular thrombectomy (EVT). Additionally, subgroup analyses were conducted to further assess the prognostic efficacy of coagulation function across different subgroups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 607 patients were enrolled, with 335 (55.19%) experiencing an unfavorable outcome. Multivariate regression analysis identified preoperative D-dimer and PTA as independent predictors of 3-month prognosis. After adjusting for confounders, elevated preoperative D-dimer levels (≥ 715 mg/L), identified by cut-off value, were a significant predictor of poor prognosis, with 2.51-fold higher risk compared to the normal range. Conversely, elevated PTA levels (≥ 85.5%) were significantly and inversely associated with poor prognosis, indicating a reduced risk of 0.39 times. Furthermore, the combination of elevated D-dimer and reduced PTA demonstrated a synergistic effect, markedly increasing the risk of poor outcomes in AIS-LVO patients. Subgroup analyses revealed that failed recanalization, comorbid diabetes, and non–middle cerebral artery (MCA) occlusion significantly influence the predictive value of D-dimer and PTA for clinical outcomes.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Elevated admission D-dimer and reduced PTA levels are independent predictors of poor prognosis in patients with AIS-LVO, and there is a synergistic interaction between the two variables.</p>\n </section>\n </div>","PeriodicalId":154,"journal":{"name":"CNS Neuroscience & Therapeutics","volume":"31 2","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cns.70267","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CNS Neuroscience & Therapeutics","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cns.70267","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The coagulation system is intrinsically linked to pathological mechanisms and progression of ischemic stroke. However, the role of preoperative coagulation function in determining the functional outcomes of acute ischemic stroke patients following large artery occlusion (AIS-LVO) has not been extensively evaluated in peer-reviewed literature.

Methods

We utilized logistic regression analyses, complemented by the construction of receiver operating characteristic (ROC) curves, to identify significant predictive factors for poor prognosis following endovascular thrombectomy (EVT). Additionally, subgroup analyses were conducted to further assess the prognostic efficacy of coagulation function across different subgroups.

Results

A total of 607 patients were enrolled, with 335 (55.19%) experiencing an unfavorable outcome. Multivariate regression analysis identified preoperative D-dimer and PTA as independent predictors of 3-month prognosis. After adjusting for confounders, elevated preoperative D-dimer levels (≥ 715 mg/L), identified by cut-off value, were a significant predictor of poor prognosis, with 2.51-fold higher risk compared to the normal range. Conversely, elevated PTA levels (≥ 85.5%) were significantly and inversely associated with poor prognosis, indicating a reduced risk of 0.39 times. Furthermore, the combination of elevated D-dimer and reduced PTA demonstrated a synergistic effect, markedly increasing the risk of poor outcomes in AIS-LVO patients. Subgroup analyses revealed that failed recanalization, comorbid diabetes, and non–middle cerebral artery (MCA) occlusion significantly influence the predictive value of D-dimer and PTA for clinical outcomes.

Conclusion

Elevated admission D-dimer and reduced PTA levels are independent predictors of poor prognosis in patients with AIS-LVO, and there is a synergistic interaction between the two variables.

Abstract Image

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.