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.

Department of Neurologic Surgery Mayo Clinic Rochester MN USA

Department of Radiology Mayo Clinic 200 1st St SW Rochester MN 55905 USA

Faculty of Medicine in Hradec Kralove Charles University Prague Czech Republic

Henry Ford Hospital Detroit MI USA

000      

00000naa a2200000 a 4500

001      

bmc24006767

003      

CZ-PrNML

005      

20240423155504.0

007      

ta

008      

240412s2024 enk f 000 0|eng||

009      

AR

024    7_

$a 10.1186/s12883-024-03579-2 $2 doi

035    __

$a (PubMed)38454378

040    __

$a ABA008 $b cze $d ABA008 $e AACR2

041    0_

$a eng

044    __

$a enk

100    1_

$a Agarwal, Tamanna $u Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic

245    10

$a High thrombin-activatable fibrinolysis inhibitor expression in thrombi from stroke patients in elevated estrogen states / $c T. Agarwal, OM. Mereuta, S. Ghozy, JLA. Larco, C. Bilgin, R. Kadirvel, W. Brinjikji, DF. Kallmes

520    9_

$a 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.

650    _2

$a lidé $7 D006801

650    _2

$a mužské pohlaví $7 D008297

650    12

$a karboxypeptidasa B2 $7 D025901

650    _2

$a fibrinolýza $7 D005342

650    _2

$a inhibitor aktivátoru plazminogenu 1 $7 D017395

650    12

$a ischemická cévní mozková příhoda $7 D000083242

650    _2

$a von Willebrandův faktor $7 D014841

650    12

$a trombóza $7 D013927

650    12

$a cévní mozková příhoda $7 D020521

650    _2

$a estrogeny $7 D004967

650    _2

$a fibrinogen $x metabolismus $7 D005340

655    _2

$a časopisecké články $7 D016428

700    1_

$a Mereuta, Oana Madalina $u Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. mereuta.oana@mayo.edu

700    1_

$a Ghozy, Sherief $u Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

700    1_

$a Larco, Jorge L Arturo $u Henry Ford Hospital, Detroit, MI, USA

700    1_

$a Bilgin, Cem $u Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

700    1_

$a Kadirvel, Ram $u Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

700    1_

$a Brinjikji, Waleed $u Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA $u Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA

700    1_

$a Kallmes, David F $u Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

773    0_

$w MED00008195 $t BMC neurology $x 1471-2377 $g Roč. 24, č. 1 (2024), s. 90

856    41

$u https://pubmed.ncbi.nlm.nih.gov/38454378 $y Pubmed

910    __

$a ABA008 $b sig $c sign $y - $z 0

990    __

$a 20240412 $b ABA008

991    __

$a 20240423155500 $b ABA008

999    __

$a ok $b bmc $g 2081012 $s 1216534

BAS    __

$a 3

BAS    __

$a PreBMC-MEDLINE

BMC    __

$a 2024 $b 24 $c 1 $d 90 $e 20240307 $i 1471-2377 $m BMC neurology $n BMC Neurol $x MED00008195

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

GRA    __

$a R01 NS105853 $p NIH HHS $2 United States

LZP    __

$a Pubmed-20240412