SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neuroepidemiology
Plasma Levels Or Activity Of ADAMTS13 And The Risk Of Ischemic Stroke And Recanalization Therapies: A Systematic Review And Meta-analysis
Provisionally accepted
- Chaoyang Central Hospital, Chaoyang, China
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Word count: 349 Background: Large vWF multimers are associated with ischemic stroke, and its thrombogenicity is controlled by ADAMTS13 ( a Disintegrin and Metalloprotease with repetitions in the ThromboSpondin motif ) . ADAMTS13 can cleaves large vWF multimers into smaller, less procoagulant forms, preventing spontaneous platelet-thrombus formation. Extensive research has been conducted on the connection between ischemic stroke and ADAMTS13 activity as well as antigen levels, but got inconsistent conclusions. More recently, contradictory findings have been reported regarding the relationship between ADAMTS13 antigen levels or activity andrecanalization therapy such as intravenous thrombolysis and mechanical thrombectomy. Methods: A thorough literature search was conducted, utilizing various online databases including MEDLINE, Cochrane Library, Web of Science, and EMBASE. This meta-analysis aimed to synthesize observational evidence on the association between ADAMTS13 antigen or activity and stroke, and to evaluate its potential influence on recanalization outcomes following intravenous thrombolysis or mechanical thrombectomy. The pooled relative risk (RR) of stroke and the standardized mean difference (SMD) of the ADAMTS13 for stroke versus control subjects, as well as their corresponding 95% confidence interval (CI) were calculated. 18 studies with a total of 8993 participants were included into this meta-analysis. Results: 1) ADAMTS13 activity was lower inpatients with ischemic stroke when compared with controls, the SMD was -1.12( 95%CI: -1.20, -1.03 ). Patients with ischemic stroke had decreased ADAMTS13 plasma antigen levels when compared to controls, the SMD was -1.32 ( 95%CI: -1.49, -1.15 ). 2) The multivariable-adjusted RR indicated that lower ADAMTS13 levels were associated with an elevated risk of ischemic stroke,the RR was 1.75 ( 95%CI: 1.4, 2.19 ) . 3) Ischemic stroke patients who achieved unfavorable outcomes following recanalization therapy exhibited lower baseline ADAMTS13 antigen levels compared to those with favorable outcomes, the SMD was -0.26 ( 95%CI: -0.51, -0.01) . No significant difference in baseline ADAMTS13 activity was observed between patients with favorable and unfavorable outcomes following recanalization therapy, the SMD was -0.05 (95%CI: -0.36, 0.26 ) . 4) The RR indicated that lower baseline ADAMTS13 levels were significantly associated with unfavorable early neurological prognosis following recanalization therapy in ischemic stroke
Keywords: Acute ischemic stroke, ADAMTS13, NIHSS score, Intravenous thrombolysis ( IVT ), Endovascular thrombectomy ( EVT ), futile recanalization, prognosis, biomarkers
Received: 17 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Li, Ding, Gao, Liu, Pei and Piao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaorui Pei
Lifeng Piao
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