Detection of prothrombotic state in ischemic stroke by monitoring plasma molecular markers.
The feasibility of using recently developed coagulation-fibrinolysis markers to detect hemostatic alteration in acute ischemic stroke was examined to see whether they may be employed as predictors of recurrence. We measured serially the plasma thrombin-antithrombin III complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC) and D-dimer in patients with ischemic stroke (53 acute, 102 chronic) and 37 normal control subjects. In the acute stage, TAT and D-dimer were significantly increased in both atherothrombotic and lacunar stroke. In cardioembolic stroke, TAT, PIC, and cross-linked D-dimer (D-dimer) were more significantly increased and reached a peak within 3 days (TAT) or at around the second week (PIC, D-dimer) poststroke. TAT, PIC, and D-dimer correlated with infarct size, but TAT and D-dimer were significantly increased even in patients with small infarcts. In the chronic stage, TAT was increased above the mean + 2 SD in 7 patients with cardioembolic stroke (n = 17), in 13 with atherothrombotic stroke (n = 37), and in 11 with lacunar stroke (n = 48). In those we had examined within 4 months before recurrence, TAT was increased above the mean + 2 SD in 7 patients (n = 8). We demonstrated TAT and D-dimer to be highly sensitive detectors of hemostatic alteration in small ischemic stroke, contrary to previous reports, and also showed that TAT can detect the prothrombotic state before recurrence.
From the Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
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Nagayama
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Shinohara
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Nagayama