Study of Hemostatic Biomarkers in Acute Ischemic Stroke by Clinical Subtype

Hirano, Kōji; Takashima, Shutaro; Dougu, Nobuhiro; Taguchi, Yoshiharu; Nukui, Takamasa; Konishi, Hirohumi; Toyoda, Shigeo; Kitajima, Isao; Tanaka, Kortaro

doi:10.1016/j.jstrokecerebrovasdis.2011.08.013

Cited by 33 publications

(29 citation statements)

References 19 publications

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“…Thus, immobile state before the onset of stroke does not seem to affect the level of plasma D -dimer in this study. Furthermore, as we have mentioned before, plasma D -dimer remains at almost the same level during the first week after stroke onset [41], which suggests that it is unlikely that plasma D -dimer level increased during the first week. Third, our small sample size did not allow us to analyze the association between D -dimer level and infarct volume in separate groups with and without warfarin treatment.…”

Section: Discussionmentioning

confidence: 68%

“…Other factors that can also elevate the D -dimer level, such as bacterial infection and venous thrombosis, usually occur after the first week of stroke onset [40]. On the other hand it has been recently shown that plasma D -dimer level remains almost the same during the first week after stroke onset [41]. In our study, we did not find a relationship between the onset-to-admission time and D -dimer level (table 3).…”

Section: Discussionmentioning

confidence: 99%

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Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Matsumoto

Sakaguchi²,

Okazaki³

et al. 2013

Cerebrovasc Dis

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Background: Plasma D-dimer level may reflect the activity of thrombus formation in the left atrium of patients with nonvalvular atrial fibrillation (NVAF). Proper anticoagulation with warfarin dramatically decreases the rate of cerebral embolism, reduces stroke severity and subsequent risk of death, as well as the level of D-dimer in NVAF patients. However, the predictive value of D-dimer level on cerebral embolism severity has not been examined. Thus, the purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in NVAF patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 h of symptom onset. We measured infarction volume from CT taken after 3 ± 1 days from the onset. Plasma D-dimer levels were measured at the time of admission. Relationships were analyzed between infarction volume and plasma D-dimer levels, cardiovascular risk factors, preadmission medications and admission conditions. We also assessed the influence of D-dimer level on functional outcome in patients with preadmission modified Rankin Scale (mRS) score of 0–1 and patients by tertile of D-dimer level (≤0.83, 0.83–2.16 and ≥2.16 µg/ml). Results: Infarction volume significantly correlated with D-dimer level (r = 0.309, p < 0.001), systolic blood pressure (r = 0.201, p = 0.026), diastolic blood pressure (r = 0.283, p = 0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r = 0.546, p < 0.001) and mRS score at discharge (r = 0.557, p < 0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume after adjusting for age, sex, current smoker or not, prothrombin time-international normalized ratio ≥1.6, diastolic blood pressure, CHADS₂ score and NIHSS score on admission. In patients with a preadmission mRS score of 0–1 (n = 108), D-dimer level was significantly associated with NIHSS score at admission (r = 0.318, p < 0.001) and mRS score at discharge (r = 0.310, p = 0.001). Patients in the highest D-dimer tertile group showed worse outcome than those in the middle (p = 0.041) and lowest (p < 0.001) tertiles. Conclusions: Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Matsumoto

Sakaguchi²,

Okazaki³

et al. 2013

Cerebrovasc Dis

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“…Our results are in line with those published by Gissel et al, who found that using a mathematical model to calculate thrombin generation (using plasma levels of clotting factors measured from patients sampled within 24 hours of symptom onset), all stroke sub-types except for cardioembolic had increased total thrombin produced [22]. Atherothrombotic strokes have different hemostatic risk factors than those of cardioembolic origin: it has been shown that the hemostatic profile is different and is more likely to be thrombogenic in atherothrombotic strokes as compared to cardioembolic strokes, which might explain our findings [23]. …”

Section: Discussionmentioning

confidence: 99%

Low thrombin generation predicts poor prognosis in ischemic stroke patients after thrombolysis

et al. 2017

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Thrombolysis by intravenous recombinant tissue plasminogen activator (rt-PA) is an effective therapy in acute ischemic stroke (AIS). Thrombin generation test (TGT) is a global hemostasis test providing information about the speed and amount of generated thrombin in plasma. Here we aimed to find out whether results of this test before the initiation of thrombolysis might predict outcomes. Study population included 120 consecutive AIS patients, all within 4.5 hours of their symptom onset, who underwent thrombolysis by rt-PA. Blood samples were collected from all patients upon admission and TGT was performed using platelet poor plasma. Clinical data of patients including the NIHSS were registered at admission, day 1 and 7 after therapy. The ASPECT score was assessed using CT images taken before and 24 hours after thrombolysis. Long-term functional outcome was defined 3 months after the event by the modified Rankin Scale. Endogenous Thrombin Potential (ETP) and Peak Thrombin were significantly lower in patients with cardioembolic IS. Symptomatic intracranial hemorrhage (SICH) was found in 6 patients and was significantly associated with low ETP and Peak Thrombin levels. A multiple logistic regression model revealed that an ETP result in the lower quartile is an independent predictor of mortality within the first two weeks (OR: 6.03; 95%CI: 1.2–30.16, p<0.05) and three months after the event (OR: 5.28; 95%CI: 1.27–21.86, p<0.05). Low levels of ETP and Peak Thrombin parameters increase the risk of therapy associated SICH. A low ETP result is an independent predictor of short- and long-term mortality following thrombolysis.

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“…The results demonstrated that the acute cerebral infarction group had higher FDP levels, but no statistical significant difference was observed in FDP between the groups (P>0.05). A recent study by Hirano et al (17) revealed that FDP levels were significantly higher in patients with acute cerebral infarction when compared with the controls (P<0.01). However, their results differ to those of the current study.…”

Section: Discussionmentioning

confidence: 88%

Evaluating the diagnostic value of vWF:Ag, D-D and FDP in patients with acute cerebral infarction using ROC curves

Shi

Xia

Feng

et al. 2014

Experimental and Therapeutic Medicine

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Cerebral infarction is usually associated with arteriosclerosis, vascular endothelial cell injury and blood flow through the vascular system. The diagnostic value of markers, including von Willebrand factor antigen (vWF:Ag), D-dimer (D-D) and fibrinogen/fibrin degradation product (FDP), have not been studied in patients with acute cerebral infarction. Thus, the aim of the present study was to use receiver operating characteristic (ROC) curves to evaluate the diagnostic significance of vWF:Ag, D-D and FDP in 94 cases of acute cerebral infarction. The results revealed that vWF:Ag and D-D concentrations were significantly higher in acute cerebral infarction patients as compared with the normal controls (P<0.01), whereas no statistically significant difference in FDP was observed between the groups (P>0.01). Plasma vWF:Ag and D-D concentrations significantly correlated with the National Institute of Health Stroke Scale (NIHSS) scores (r=0.625 and 0.582, respectively; P<0.01). In addition, the vWF:Ag concentration significantly correlated with the D-D concentration (r=0.320; P<0.01), whereas FDP concentration did not correlate with D-D or vWF:Ag concentrations or the NIHSS scores (r=0.172, 0.188 and 0.065, respectively; P>0.05). The area under the ROC curve using vWF:Ag as a diagnostic marker in patients with acute cerebral infarction was 0.900, while for D-D the area was 0.795 and for FDP the area was 0.465. Logistic regression analysis revealed that the odds ratios of vWF:Ag and D-D were 16.727 and 2.324, respectively, which were statistically significant (P<0.001 and 0.023, respectively). These results indicated that using vWF:Ag as a diagnostic marker is likely to significantly improve the sensitivity of diagnosing patients with acute cerebral infarction. The diagnostic value of vWF:Ag concentration was significantly higher compared with D-D and FDP levels.

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Study of Hemostatic Biomarkers in Acute Ischemic Stroke by Clinical Subtype

Cited by 33 publications

References 19 publications

Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Relationship between Plasma <smlcap>D</smlcap>-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Low thrombin generation predicts poor prognosis in ischemic stroke patients after thrombolysis

Evaluating the diagnostic value of vWF:Ag, D-D and FDP in patients with acute cerebral infarction using ROC curves

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