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

2019; Lippincott Williams & Wilkins; Volume: 93; Issue: 9 Linguagem: Inglês

10.1212/wnl.0000000000007997

1526-632X

Caty Carrera, Natàlia Cullell, Nuria P. Torres‐Aguila, 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, Cristòfol Vives-Bauzà, Rosa Díaz-Navarro, Vı́ctor Obach, Juan F. Arenillas, Tomás Segura, Gemma Serrano‐Heras, Joan Martí‐Fàbregas, Marimar Freijó, Juan Antonio Cabezas, Turgut Tatlisumak, Laura Heitsch, Laura Ibáñez, Carlos Cruchaga, Jin‐Moo Lee, Daniel Strbian, Joan Montaner, Israel Fernández‐Cadenas,

Blood Coagulation and Thrombosis Mechanisms

Objective 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. Methods 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. Results 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). Conclusion 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.