title: Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke.
abstract: BACKGROUND
  It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke.
  
  
  RESULTS
  Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum levels of FM was significantly higher in patients with left atrial appendage (LAA) thrombus formation (n=24) than in those with no thrombus (88+/-52 vs 14+/-9 microg/ml, p<0.0001). On multivariate logistic regression analysis, FM was an independent predictor for LAA thrombus (RR 2.975, 95% confidence interval 1.114 to 4.820, p=0.0214). In patients with LAA thrombus negative group, cases with LAA emptying flow velocity at atrial systole that was absent or smaller than at early diastole had significantly higher FM levels as compared to cases with larger velocity (42+/-12 vs 8+/-5 microg/ml, p<0.0001).
  
  
  CONCLUSIONS
  Higher levels of serum FM reflect LAA flow pattern alterations and thrombus formation in patients with acute ischemic stroke.
authors.affiliation: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Okuyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000473:pathology / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D003331:Coronary Vessels; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications / Q000175:diagnosis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis; D019851:Thrombophilia / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C011468:fibrinmonomer