Relationship between coagulation function indicators and neurological outcome following rt-PA thrombolysis in acute ischaemic stroke
- 1Department of Neurology, Beijing Shunyi Hospital, Beijing, China
Abstract
Aim: To assess the relationship between baseline coagulation parameters and 90-day neurological functional status in patients with acute ischaemic stroke (AIS) undergone intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.
Methods: We implemented a retrospective cohort study of 200 AIS patients who underwent intravenous rt-PA thrombolysis from January 2024 to December 2025. Baseline coagulation parameters were measured before thrombolysis. The primary outcome was poor functional outcome [modified Rankin Scale (mRS) score 3–6 at 90 days]. Multivariable logistic regression was used to estimate adjusted associations between baseline variables and 90-day outcome. A four-marker logistic model was explored, and receiver operating characteristic (ROC) analysis was used to describe its apparent discrimination within the study cohort.
Results: Of the 200 enrolled patients, poor 90-day functional status was seen in 68 (34.0%). The baseline D-dimer (2.18 ± 1.64 vs. 0.87 ± 0.65 mg/L, P < 0.001), fibrinogen (3.82 ± 0.91 vs. 3.15 ± 0.76 g/L, P < 0.001), PT (12.84 ± 1.12 vs. 12.15 ± 0.89 s, P < 0.001) and APTT (32.56 ± 3.42 vs. 29.87 ± 2.65 s, P < 0.001) levels were higher in the poor outcome group than the favourable outcome group. In multivariable analysis, elevated D-dimer (OR = 2.143, 95% CI = 1.452–3.162, P < 0.001), increased fibrinogen (OR = 1.876, 95% CI = 1.123–3.134, P = 0.016) and prolonged APTT (OR = 1.215, 95% CI = 1.032–1.431, P = 0.019) remained associated with poor 90-day functional status after adjustment for the measured covariates included in the model. The four-coagulation-marker model had an apparent AUC of 0.812 (95% CI = 0.735–0.888) in the same cohort.
Conclusion: Baseline D-dimer, fibrinogen and APTT were associated with 90-day neurological functional status among AIS patients treated with intravenous rt-PA. These markers should not be interpreted as stand-alone predictors of outcome; their incremental prognostic value beyond established clinical factors and their clinical utility require prospective external validation.
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BibTeX
@article{han2026relationship,
title = {{Relationship between coagulation function indicators and neurological outcome following rt-PA thrombolysis in acute ischaemic stroke}},
author = {Jing Han and Quping Ouyang and Yue Li},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1965269},
url = {https://doi.org/10.3389/fmed.2026.1965269},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Relationship between coagulation function indicators and neurological outcome following rt-PA thrombolysis in acute ischaemic stroke
AU - Jing Han
AU - Quping Ouyang
AU - Yue Li
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1965269
UR - https://doi.org/10.3389/fmed.2026.1965269
AB - Aim: To assess the relationship between baseline coagulation parameters and 90-day neurological functional status in patients with acute ischaemic stroke (AIS) undergone intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. Methods: We implemented a retrospective cohort study of 200 AIS patients who underwent intravenous rt-PA thrombolysis from January 2024 to December 2025. Baseline coagulation parameters were measured before thrombolysis. The primary outcome was poor functional outcome [modified Rankin Scale (mRS) score 3–6 at 90 days]. Multivariable logistic regression was used to estimate adjusted associations between baseline variables and 90-day outcome. A four-marker logistic model was explored, and receiver operating characteristic (ROC) analysis was used to describe its apparent discrimination within the study cohort. Results: Of the 200 enrolled patients, poor 90-day functional status was seen in 68 (34.0%). The baseline D-dimer (2.18 ± 1.64 vs. 0.87 ± 0.65 mg/L, P < 0.001), fibrinogen (3.82 ± 0.91 vs. 3.15 ± 0.76 g/L, P < 0.001), PT (12.84 ± 1.12 vs. 12.15 ± 0.89 s, P < 0.001) and APTT (32.56 ± 3.42 vs. 29.87 ± 2.65 s, P < 0.001) levels were higher in the poor outcome group than the favourable outcome group. In multivariable analysis, elevated D-dimer (OR = 2.143, 95% CI = 1.452–3.162, P < 0.001), increased fibrinogen (OR = 1.876, 95% CI = 1.123–3.134, P = 0.016) and prolonged APTT (OR = 1.215, 95% CI = 1.032–1.431, P = 0.019) remained associated with poor 90-day functional status after adjustment for the measured covariates included in the model. The four-coagulation-marker model had an apparent AUC of 0.812 (95% CI = 0.735–0.888) in the same cohort. Conclusion: Baseline D-dimer, fibrinogen and APTT were associated with 90-day neurological functional status among AIS patients treated with intravenous rt-PA. These markers should not be interpreted as stand-alone predictors of outcome; their incremental prognostic value beyond established clinical factors and their clinical utility require prospective external validation.
SN - 2296-858X
ER -