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

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-HerasJoan 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

Research output: Contribution to journalArticleResearch

4 Citations (Scopus)

Abstract

© 2019 American Academy of Neurology. 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.
Original languageEnglish
Pages (from-to)e851-e863
JournalNeurology
Volume93
Issue number9
DOIs
Publication statusPublished - 27 Aug 2019

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