title: Antithrombin III associated with fibrinogen predicts the risk of cerebral ischemic stroke.
abstract: OBJECTIVE
  The purpose of this study is to examine the feasibility of developing plasma predictive value biomarkers of cerebral ischemic stroke before imaging evidence is acquired.
  
  
  METHODS
  Blood samples were obtained from 198 patients who attended our neurology department as emergencies - with symptoms of vertigo, numbness, limb weakness, etc. - within 4.5 h of symptom onset, and before imaging evidence was obtained and medical treatment. After the final diagnosis was made by MRI/DWI/MRA or CTA in the following 24-72 h, the above cases were divided into two groups: stroke group and non-stroke group according to the imaging results. The levels of baseline plasma antithrombin III (AT-III), thrombin-antithrombin III (TAT), fibrinogen, D-dimer and high-sensitivity C-reactive protein (hsCRP) in the two groups were assayed.
  
  
  RESULTS
  The level of the baseline AT-III in the stroke group was 118.07±26.22%, which was lower than that of the non-stroke group (283.83±38.39%). The levels of TAT, fibrinogen, hsCRP were 7.24±2.28 μg/L, 5.49±0.98 g/L, and 2.17±1.07 mg/L, respectively, which were higher than those of the non-stroke group (2.53±1.23 μg/L, 3.35±0.50 g/L, 1.82±0.67 mg/L). All the P-values were less than 0.001. The D-dimer level was 322.57±60.34 μg/L, which was slightly higher than that of the non-stroke group (305.76±49.52 μg/L), but the P-value was 0.667. The sensitivities of AT-III, TAT, fibrinogen, D-dimer and hsCRP for predicting ischemic stroke tendency were 97.37%, 96.05%, 3.29%, 7.89%, but the specificity was 93.62%, 82.61%, 100% and 100%, respectively, and all the P-values were less than 0.001. High levels of D-dimer and hsCRP were mainly seen in the few cases with severe large-vessel infarction.
  
  
  CONCLUSIONS
  Clinical manifestations of acute focal neurological deficits were associated with plasma AT-III and fibrinogen. These tests might help the risk assessment of acute cerebral ischemic stroke and/or TIA with infarction tendency in the superacute stage before positive imaging evidence is obtained.
authors.affiliation: Division of Neurology, Shijitan Hospital, The Ninth Clinical Medical College of Beijing University, Beijing 100038, China. victor65@126.com
authors.forename: Ran
authors.initials: R
authors.lastname: Meng
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Li
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.forename: Sui
authors.initials: S
authors.lastname: Meng
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis*; D015415:Biomarkers / Q000097:blood*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000191:economics; D002097:C-Reactive Protein / Q000032:analysis; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000191:economics / Q000209:etiology; D013917:Thrombin / Q000032:analysis; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; D000990:Antithrombin III; D005340:Fibrinogen; D002097:C-Reactive Protein; D013917:Thrombin; D010959:Tissue Plasminogen Activator