High thrombin-activatable fibrinolysis inhibitor expression in thrombi from stroke patients in elevated estrogen states
Recommended Citation
Agarwal T, Mereuta OM, Ghozy S, Larco JLA, Bilgin C, Kadirvel R, Brinjikji W, and Kallmes DF. High thrombin-activatable fibrinolysis inhibitor expression in thrombi from stroke patients in elevated estrogen states. BMC Neurol 2024; 24(1):90.
Document Type
Article
Publication Date
3-7-2024
Publication Title
BMC neurology [electronic resource]
Abstract
BACKGROUND: The risk of acute ischemic stroke (AIS) associated with high estrogen states, including pregnant patients and those using oral contraceptives, has been well documented. We described the histological composition of thrombi collected in these cases.
METHODS: From a prospective tissue registry (STRIP registry) of thrombi retrieved during mechanical thrombectomy for AIS, we identified 5 patients with high estrogen states: 1 post-partum patient, 1 undergoing hormone replacement therapy and 3 consuming oral contraceptive pills. Five male control patients were randomly chosen matched by age. Immunohistochemistry for CD42b (platelets), von Willebrand factor (vWF), thrombin-activatable fibrinolysis inhibitor (TAFI), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) was performed. Expression was quantified using Orbit Image Software. Student's t-test was performed as appropriate.
RESULTS: Mean TAFI content for the high estrogen state group was higher than controls (25.6 ± 11.9% versus 9.3 ± 9.0%, p = 0.043*). Mean platelet content for the high estrogen state group was lower than controls (41.7 ± 10.6% versus 61.8 ± 12.9%, p = 0.029*). No significant difference was found in vWF, fibrinogen and PAI-1 expression. Mean time to recanalize was higher in the high estrogen state group compared to the control group (57.8 ± 27.6 versus 22.6 ± 11.4 min, p = 0.0351*). The mean number of passes required was higher in the high estrogen group compared to controls 4.6 versus 1.2, p = 0.0261*).
CONCLUSIONS: TAFI expression, a powerful driver of thrombosis, was significantly higher in stroke thrombi among patients with high estrogen states compared to controls.
Medical Subject Headings
Humans; Male; Carboxypeptidase B2; Fibrinolysis; Plasminogen Activator Inhibitor 1; Ischemic Stroke; von Willebrand Factor; Thrombosis; Stroke; Estrogens; Fibrinogen
PubMed ID
38454378
Volume
24
Issue
1
First Page
90
Last Page
90
