J Thromb Thrombolysis. 2026 May 13. doi: 10.1007/s11239-026-03306-3. Online ahead of print.
ABSTRACT
Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulation, fibrinolysis, and endothelial dysfunction remains incompletely understood. In this retrospective cohort study, 91 patients with AIS treated with intravenous thrombolysis were included between November 2022 and February 2025. Plasma levels of thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) were measured before thrombolysis and at 1, 6, and 24 h thereafter. Stroke etiology was classified according to the Trial of Org 10,172 in Acute Stroke Treatment criteria into large artery atherosclerosis (LAA) and small vessel disease (SVD) subtypes, and patients were further categorized into END and non-END groups. Patients with LAA exhibited significantly higher plasma TAT levels at all time points and a higher incidence of END than those with SVD. Plasma TM levels were higher in the non-END group, with statistically significant differences observed at 24 h after thrombolysis. Multivariable analysis identified higher TM levels at 24 h as an independent protective factor against END, whereas elevated t-PAIC levels were independently associated with increased END risk. Given that END may occur early after thrombolysis, these associations should be interpreted cautiously in terms of temporal sequence. A combined model incorporating TM and t-PAIC demonstrated good discriminative performance for END, with an area under the curve of 0.849. These findings indicate distinct coagulation-endothelial response patterns between AIS subtypes and suggest that TM and t-PAIC may serve as complementary biomarkers associated with END risk following intravenous thrombolysis, although further validation is required.
PMID:42126778 | DOI:10.1007/s11239-026-03306-3
