title: Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression.
abstract: OBJECTIVE
  Early clinical progression of ischemic stroke is common and is associated with increased risk of death and dependency. We hypothesized that activation of the coagulation system is an important contributor in some cases of deterioration. We aimed to characterize alterations in circulating hemostatic markers in patients with progressing stroke.
  
  
  METHODS
  Consecutive acute ischemic stroke admissions were recruited. Progressing stroke was defined by deterioration in components of the Scandinavian Stroke Scale. Hemostatic markers (coagulation factors VIIc, VIIIc, and IXc, prothrombin fragments 1+2 [F1+2], thrombin-antithrombin complexes [TAT], D-dimer, fibrinogen, von Willebrand factor [vWF] and tissue plasminogen activator) were measured within 24 hours of symptom recognition.
  
  
  RESULTS
  Fifty-four (25%) of the 219 patients met criteria for progressing stroke. F1+2 (median 1.28 versus 1.06 nmol/L, P=0.01), TAT (5.28 versus 4.07 microg/L, P<0.01), D-dimer (443 versus 194 ng/mL, P<0.001) and vWF (216 versus 198 IU/dL, P<0.05) levels were higher in these patients than in stable/improving patients. In logistic regression analysis, with all important clinical and laboratory variables included, only natural log D-dimer (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.38 to 2.54; P=0.0001) and mean arterial blood pressure (OR: 1.26 per 10 mm Hg change; 95% CI: 1.05 to 1.51; P=0.01) remained independent predictors of progressing stroke.
  
  
  CONCLUSIONS
  There is evidence of excess thrombin generation and fibrin turnover in patients with progressing ischemic stroke. Measurement of D-dimer levels can identify patients at high risk for stroke progression. Further research is required to determine whether such patients benefit from acute interventions aimed at modifying hemostatic function.
authors.affiliation: University Section of Clinical Gerontology and Vascular Medicine, Royal Infirmary, Glasgow, UK. M.Barber@clinmed.gla.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Barber
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.forename: Ann
authors.initials: A
authors.lastname: Rumley
authors.forename: Gordon D O
authors.initials: GD
authors.lastname: Lowe
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D