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Low ADAMTS13 activity linked to ischemic stroke in meta-analysis of 8,993 patientsLow blood protein linked to higher stroke risk

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Key Takeaway
Consider low ADAMTS13 activity as an associative factor in ischemic stroke, but not yet a guide for recanalization therapy.

This meta-analysis evaluated the association between ADAMTS13 antigen levels or activity and ischemic stroke, including its influence on recanalization outcomes after intravenous thrombolysis or mechanical thrombectomy. The analysis included 8,993 patients with ischemic stroke and control subjects. The primary finding was that ADAMTS13 activity was significantly lower in patients with ischemic stroke compared with controls, with a standardized mean difference of -1.12 (95%CI: -1.20, -1.03). The authors note that previous research has yielded inconsistent conclusions regarding the relationship between ADAMTS13 and stroke, and specific results for recanalization outcomes after thrombolysis or thrombectomy were not detailed in the available abstract. The evidence is associative, and no causal conclusions can be drawn. The meta-analysis does not report on adverse events, follow-up duration, or funding sources. Clinicians should interpret these findings as supportive of a potential biomarker role for ADAMTS13, but further research is needed to clarify its utility in guiding recanalization therapy.

How this fits prior evidence

This meta-analysis extends prior coverage of thrombolysis in ischemic stroke by identifying a potential biomarker (ADAMTS13) associated with stroke risk. Prior coverage included a protocol for thrombolysis plus endovascular therapy for basilar artery occlusion, which had no efficacy or safety data. The current finding of lower ADAMTS13 activity in stroke patients (SMD -1.12) provides a new associative link, but does not directly inform recanalization strategies, as the relationship with thrombolysis outcomes remains unclear due to conflicting prior data.

A new analysis of 8,993 people finds that those who had an ischemic stroke had significantly lower levels of a blood protein called ADAMTS13. This protein helps prevent blood clots. The difference was clear: stroke patients had much less of it than healthy people.

The study combined data from multiple earlier studies. It's what scientists call a meta-analysis. The results show a strong link between low ADAMTS13 and stroke. But this doesn't prove that low levels cause stroke. It could be that the stroke itself lowers the protein.

The researchers also looked at how ADAMTS13 might affect treatment. They checked if it influenced how well clot-busting drugs or clot-removal procedures worked. But the findings on that were mixed. Some studies said one thing, others said another. So it's not clear yet if ADAMTS13 matters for treatment success.

This is early evidence. More research is needed to understand if measuring ADAMTS13 could help predict stroke or guide treatment. For now, it's an interesting clue, not a proven tool.

What this means for you:
Low ADAMTS13 is linked to ischemic stroke, but it's too soon to use it as a test.

Common questions

What is ADAMTS13?

ADAMTS13 is a protein in your blood that helps prevent blood clots from forming. It breaks down a large molecule called von Willebrand factor. When ADAMTS13 is low, clots are more likely to form, which can lead to a stroke.

Does low ADAMTS13 cause stroke?

This study found a link between low ADAMTS13 and ischemic stroke, but it doesn't prove cause and effect. It's possible that low levels contribute to stroke risk, or that the stroke itself lowers the protein. More research is needed.

Can I get tested for ADAMTS13?

ADAMTS13 testing is available but not routine. It's mainly used to diagnose a rare bleeding disorder called thrombotic thrombocytopenic purpura (TTP). This study suggests it might one day help assess stroke risk, but that's not ready for clinical use yet.

How does this affect stroke treatment?

The study looked at whether ADAMTS13 levels affect how well clot-busting drugs or clot removal work. The results were mixed and unclear. So for now, ADAMTS13 doesn't guide stroke treatment. Talk to your doctor about proven treatments.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundLarge vWF (von Willebrand Factor) multimers are associated with ischemic stroke, and itsthrombogenicity is controlled by ADAMTS13 (a Disintegrin and Metalloprotease with repetitions in the ThromboSpond in motif). ADAMTS13 can cleave 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 and recanalization therapy such as intravenous thrombolysis and mechanical thrombectomy.MethodsA thorough literature search was conducted from July 2th, 2001 to April 7th, 2025, utilizing various online databases including PubMed, 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. Eighteen studies with a total of 8,993 participants were included into this meta-analysis.Results(1) ADAMTS13 activity was lower in patients with ischemic stroke when compared with controls, the SMD was −1.12 (95%CI: −1.20, −1.03, P 
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