ArticleJournal of the American Heart Association2026
Neutrophil Extracellular Traps Are Associated With Early Neurological Deterioration in Patients With Acute Ischemic Stroke Receiving Intravenous Thrombolysis: A Prospective Cohort Study.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- NET-mediated immunothrombosis in ischemic stroke: pathobiology, biomarkers, and therapeutic targeting.Thrombosis journal · 2026Review
- NETs and the thrombo-immune microenvironment: immune heterogeneity in recanalization, reperfusion, hemorrhagic transformation, and antithrombotic strategies.Frontiers in neurology · 2026Review
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Authors and funding
22 authors.
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Abstract
backgroundNeutrophil extracellular traps contribute to thrombolytic resistance and the no-reflow phenomenon after acute ischemic stroke, thereby impairing microvascular reperfusion and leading to unfavorable clinical outcomes. This study investigated the association between prethrombolytic circulating neutrophil extracellular trap biomarkers, CitH3 (citrullinated histone 3) and MPO (myeloperoxidase)-DNA complexes, and early neurological deterioration (END) in patients with acute ischemic stroke treated with intravenous thrombolysis alone.
methodsWe prospectively enrolled patients with acute ischemic stroke who received standard-dose alteplase within 4.5 hours of symptom onset (January 2019-April 2023). Venous blood was drawn before intravenous thrombolysis to measure serum CitH3 and MPO-DNA. The primary outcome was END, defined as an increase of ≥4 points in NIHSS score at 24 hours versus baseline. Logistic regression with restricted cubic splines assessed associations between neutrophil extracellular trap biomarkers and END.
resultsAmong 287 patients (mean age 61.69±12.41 years, 70.4% male), 45 (15.7%) developed END. Serum CitH3 >17.67 ng/mL (odds ratio [OR], 3.81 [95% CI, 1.75-8.29]) and MPO-DNA >79.72 ng/mL (OR, 5.58 [95% CI, 2.36-13.21]) were independently associated with END. The associations remained significant when treated as continuous variables. Restricted cubic splines confirmed a linear dose-response relationship between higher CitH3 levels and END risk (
conclusionsSerum neutrophil extracellular traps may serve as promising biomarkers associated with END after intravenous thrombolysis in patients with acute ischemic stroke.
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