ApoE genotype influences on efficacy and safety of thrombolytic treatment for ischemic stroke

Introduction. Apolipoprotein E has been associated with intracerebral hemorrhages and with neurological outcome of ischemic stroke patients treated with rt-PA. Therefore, we hypothesized that ApoE genotype might influence the appearance of post-tPA hemorrhagic transformation and that the favorable outcome of E2 patients might be due to better rates of recanalization. Patients and methods. We analyzed the ApoE genotype of 77 patients with ischemic stroke involving the territory of the middle cerebral artery who received rt-PA within 3 h of symptoms onset. The hemorrhagic events were evaluated by computed tomography and the arterial recanalization by transcraneal doppler. Results. We did not observe any association between ApoE genotypes and the rates of hemorrhagic transformation following rt-PA treatment (E2 = 33.3 %, E3 = 32.70/0, E4 = 11.8%; p = 0.241). Rates of artery recanalization following thrombolysis were similar regarding ApoE genotypes at 1 hour post-tPA administration (E2 = 40%, E3 + E4 = 45.9%; p = 0.799), at 6 hours post-tPA (E2 = 80%, E3+E4 = 62.3%; p = 0.43) or at 24 hours post-tPA (E2 = 100%, E3 + E4 = 75%, p = 0.203). No association was observed between ApoE genotypes and NIHSS scores at 48 hours (E2 = 8, E3 + E4 = 12; p = 0.811) nor with the modified ranking scale at 3 months (E2 = 1.5, E3 + E4 = 4; p = 0.350). Conclusions. In our group of stroke patients, ApoE genotypes are not related with the presence of hemorrhagic transformations neither with the rates of recanalization following thrombolytic treatment.