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Validation of a clinical-genetics score to predict hemorrhagic transformations after rtPA.

Journal article
Authors Caty Carrera
Natalia Cullell
Nuria Torres-Águila
Elena Muiño
Alejandro Bustamante
Antonio Dávalos
Elena López-Cancio
Marc Ribó
Carlos A Molina
Eva Giralt-Steinhauer
Carolina Soriano-Tárraga
Marina Mola-Caminal
Jordi Jiménez-Conde
Jaume Roquer
Cristófol Vives-Bauza
Rosa Díaz Navarro
Victor Obach
Juan Francisco Arenillas
Tomás Segura
Gemma Serrano-Heras
Joan Martí-Fàbregas
Marimar Freijo
Juan Antonio Cabezas
Turgut Tatlisumak
Laura Heitsch
Laura Ibañez
Carlos Cruchaga
Jin-Moo Lee
Daniel Strbian
Joan Montaner
Israel Fernández-Cadenas
Published in Neurology
Volume 93
Issue 9
Pages e851-e863
ISSN 1526-632X
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages e851-e863
Language en
Links dx.doi.org/10.1212/WNL.000000000000...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Neurology

Abstract

To validate the Genot-PA score, a clinical-genetic logistic regression score that stratifies the thrombolytic therapy safety, in a new cohort of patients with stroke.We enrolled 1,482 recombinant tissue plasminogen activator (rtPA)-treated patients with stroke in Spain and Finland from 2003 to 2016. Cohorts were analyzed on the basis of ethnicity and therapy: Spanish patients treated with IV rtPA within 4.5 hours of onset (cohort A and B) or rtPA in combination with mechanical thrombectomy within 6 hours of onset (cohort C) and Finnish participants treated with IV rtPA within 4.5 hours of onset (cohort D). The Genot-PA score was calculated, and hemorrhagic transformation (HT) and parenchymal hematoma (PH) risks were determined for each score stratum.Genot-PA score was tested in 1,324 (cohort A, n = 726; B, n = 334; C, n = 54; and D, n = 210) patients who had enough information to complete the score. Of these, 213 (16.1%) participants developed HT and 85 (6.4%) developed PH. In cohorts A, B, and D, HT occurrence was predicted by the score (p = 2.02 × 10-6, p = 0.023, p = 0.033); PH prediction was associated in cohorts A through C (p = 0.012, p = 0.034, p = 5.32 × 10-4). Increased frequency of PH events from the lowest to the highest risk group was found (cohort A 4%-15.7%, cohort B 1.5%-18.2%, cohort C 0%-100%). The best odds ratio for PH prediction in the highest-risk group was obtained in cohort A (odds ratio 5.16, 95% confidence interval 1.46-18.08, p = 0.009).The Genot-PA score predicts HT in patients with stroke treated with IV rtPA. Moreover, in an exploratory study, the score was associated with PH risk in mechanical thrombectomy-treated patients.

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