Thrombin generation in acute cardioembolic and non-cardioembolic ischemic stroke.
OBJECTIVE
Increased thrombin generation, as measured by the Calibrated Automated Thrombogram (CAT), has recently been reported to predict ischemic stroke, especially stroke with a cardioembolic source. However, there are few studies on thrombin generation using CAT in patients with manifest ischemic stroke, particularly in patients with cardioembolic stroke not yet on anticoagulation.


METHODS
Therefore, a prospective cohort study of 205 stroke patients > 45 years of age was performed. They were recruited during their hospital stay or shortly thereafter. Inclusion criteria were ischemic stroke or TIA within two weeks and no atrial fibrillation (AF) in the history or at inclusion. Patients received a thumb ECG device in order to detect silent AF. Blood samples were collected at inclusion and after 1 month. Thrombin generation in plasma after addition of tissue factor was assessed in patients and in healthy controls.


RESULTS
Mean age of patients was 72 ± 7 years and 43% were females. Peak thrombin concentrations were variable among stroke patients but overall significantly higher at both time points (p < 0.0001) compared to controls, and tended to be highest in patients in whom paroxysmal atrial fibrillation was subsequently documented.


CONCLUSIONS
Thrombin generation in patients with acute cardioembolic and non-cardioembolic schemic stroke/TIA is variable but overall higher compared to healthy subjects. The long-term prognostic value of thrombin generation in patients with a recent ischemic stroke deserves further investigation.
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital.
Elisabeth
E
Rooth
Piotr
P
Sobocinski-Doliwa
Jovan
J
Antovic
Veronika
V
Frykman Kull
Magnus
M
Von Arbin
Mårten
M
Rosenqvist
Håkan
H
Wallén
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood; D002545:Brain Ischemia / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000378:metabolism*
D002097:C-Reactive Protein; D013917:Thrombin