Relationship between coagulation function indicators and neurological outcome following rt-PA thrombolysis in acute ischaemic stroke
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Updated: Nov 6, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Jing Han1, Quping Ouyang1, Yue Li1
1Department of Neurology, Beijing Shunyi Hospital, Beijing, China.
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.
