Time Course of Platelet Activation and von Willebrand Factor in Patients With Non-Valvular Atrial Fibrillation After Ischemic Stroke  Evaluation of Prognostic Determinants

Yip, Hon‐Kan; Lai, Shung-Lon; Lan, Min‐Yu; Chang, Wen-Neng; Liu, Josef S.; Kao, Yi-Fen; Chang, Yung‐Yee; Lu, Cheng-Hsien; Chen, Wei-Hsi; Hung-Hseng, Lin; Liou, Chia‐Wei

doi:10.1253/circj.71.321

Cited by 15 publications

(15 citation statements)

References 31 publications

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“…Separate analysis of hs (high sensitivity)‐CRP [21–24] and CRP levels [25–27] removed the high heterogeneity present in the combined analysis (combined, I 2 = 93%, P = 0.00001; hs‐CRP only, I 2 = 32%, P = 0.22; and CRP only, I 2 = 22%, P = 0.28), but found little difference in the distinguishing power of hs‐CRP over CRP assays (hs‐CRP, MD 5.94 mg l −1 , 95% CI 4.11, 7.78; P = 0.00001; and CRP, MD 0.42 mg l −1 , 95% CI 0.24, 0.60; P = 0.00001).…”

Section: Resultsmentioning

confidence: 99%

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Hasan

McColgan

Bentley

et al. 2012

Brit J Clinical Pharma

102

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECTStroke is the largest single cause of disability in the UK. While tests based upon biomarkers have been around for decades, interest in the applications of biomarkers has increased greatly in recent years. Biomarkers released into the bloodstream following a stroke are useful not only for understanding the pathogenesis of stroke, but also play a significant role in the development of personalised medicine. The efficacy of current clinical models and imaging techniques for the diagnosis and prognosis of acute stroke could be improved when used in conjunction with blood biomarkers. While several studies have proposed a number of biomarkers associated with acute stroke in humans, there is conflicting information about the significance of implicated markers, and their clinical relevance is unclear. WHAT THIS STUDY ADDSIn an attempt to consolidate the plethora of data in this field, we have conducted a comprehensive systematic review and meta-analysis of proteomic and metabolomic blood biomarkers associated with acute stroke. Our meta-analysis has found eight biomarkers that are significantly associated with the diagnosis and prognosis of acute stroke. Interestingly we also found that CRP, a protein commonly implicated as a strong biomarker of inflammation and stroke, may not have sufficient sensitivity and specificity to be of clinical value, Thus while the biomarkers identified through our study are likely to be biologically informative about the mechanisms of vascular disease, their clinical potential for a blood-based test warrants further investigation. AIMSIdentification of biomarkers for stroke will aid our understanding of its aetiology, provide diagnostic and prognostic indicators for patient selection and stratification, and play a significant role in developing personalized medicine. We undertook the largest systematic review conducted to date in an attempt to characterize diagnostic and prognostic biomarkers in acute ischaemic and haemorrhagic stroke and those likely to predict complications following thrombolysis. METHODSA comprehensive literature search was carried out to identify diagnostic and prognostic stroke blood biomarkers. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for each biomarker. RESULTSWe identified a total of 141 relevant studies, interrogating 136 different biomarkers. Three biomarkers (C-reactive protein, P-selectin and homocysteine) significantly differentiated between ischaemic stroke and healthy control subjects. Furthermore, glial fibrillary acidic protein levels were significantly different between haemorrhagic stroke and ischaemic stroke patients (MD 224.58 ng l -1 ; 95% CI 25.84, 423.32; P = 0.03), high levels of admission glucose were a strong predictor of poor prognosis after ischaemic stroke and symptomatic intracerebral haemorrhage post-thrombolysis, glutamate was found to be an indicator of progressive (unstable) stroke (MD 172.65 mmol l -1 , 95% CI 130.54, 214.75; P = 0.00001), D-dimer predicted in-hospi...

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Section: Resultsmentioning

confidence: 99%

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Hasan

McColgan

Bentley

et al. 2012

Brit J Clinical Pharma

102

View full text Add to dashboard Cite

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“…Furthermore, blood sampling was standardized and performed at two time points, whereof one was in the chronic phase. Only a few previous studies [5][6][7]11,17] have examined VWF levels at more than one well-defined time-point. There are also some limitations that should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, high plasma levels of VWF have been identified as a predictor of stroke in three prospective studies of subjects with and without atrial fibrillation [12][13][14]. However, other case-control and prospective studies have not found an association between VWF and IS [15][16][17][18]. IS is a more heterogeneous disease than CHD, and there are no systematic studies on VWF in relation to the etiologic subtypes of IS.…”

Section: Introductionmentioning

confidence: 99%

Plasma levels of von Willebrand factor in the etiologic subtypes of ischemic stroke

Hanson

Jood

Karlsson

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: Compared with coronary artery disease, there are few studies on von Willebrand factor (VWF) in ischemic stroke (IS). Moreover, there is little information on VWF in the etiologic subtypes of IS. Objectives: The aim of the present study was to investigate VWF in IS and in the etiologic subtypes of IS. Patients/methods: The Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) is a case-control study comprising 600 patients and 600 matched controls. Etiologic IS subtype was defined according to the TOAST criteria. Blood sampling was performed in the acute phase and after 3 months. Results: The levels of VWF were increased in overall IS, at both time-points. The 3-month VWF levels were increased in the subtypes of large-vessel disease (LVD), cardioembolic (CE) stroke and cryptogenic stroke, but not in the subtype of smallvessel disease (SVD), as compared with the controls. The acute phase VWF levels were significantly increased in all four subtypes. In the multivariate regression analysis, with vascular risk factors as covariates, the 3-month VWF levels were associated with CE stroke and cryptogenic stroke, and the acute phase VWF levels with all subtypes. There were significant subtype-specific differences in VWF, with the highest levels in LVD and CE stroke. Conclusions: The present results show that VWF levels are increased in patients with IS. Furthermore, the VWF levels differ between etiologic IS subtypes and thus, it is important to consider etiologic subtypes in future studies of VWF in patients with IS.

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“…Some studies reported that vWF level is increased in ischemic stroke patients and higher plasma level of vWF is associated with a higher risk for ischemic stroke [21]. By contrast, some case–control and prospective studies did not find an association between vWF and ischemic stroke [22]. Recently, a large case–control study comprising 600 patients with 600 matched controls studied the relationship between vWF and etiologies and subtypes of ischemic stroke.…”

Section: Vascular Injury-related Markersmentioning

confidence: 99%

Potential serum biomarkers in the pathophysiological processes of stroke

Miao

Liao²

2014

Expert Review of Neurotherapeutics

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Stroke is a leading cause of death and serious long-term disability. Ischemic stroke is the major subtype of stroke. Currently, its diagnosis is mainly dependent upon clinical symptoms and neuroimaging techniques. Despite these clinical and imaging modalities, often strokes are not recognized after initial onset. As early intervention of medical or surgical therapy is often associated with improved outcomes, there is an urgent need to improve the speed and accuracy of stroke diagnosis. Stroke is a complex pathophysiological process involving; energy failure, imbalance of ion homeostasis, acidosis, intracellular calcium overload, neuronal excitotoxicity, free radical-mediated lipid oxidation, inflammatory cell infiltration, and glial cell activation. These events ultimately lead to neuronal apoptotic cell death or necrosis. In this review, we have summarized the serum biomarkers according to the pathophysiological processes of stroke, which have been intensively studied in clinical trials of stroke over the past five years, and also used Medline's 'related article' option to identify further articles. We focused on the potential biomarkers pertaining to vascular injury, metabolic changes, oxidative injury, and inflammation, and newly studied biomarkers, and discussed how these biomarkers could be used for the diagnosis or determining the prognosis of stroke. Keywordsbiomarkers; cerebral ischemia; clinical trial; pathophysiology; stroke Stroke is a leading cause of death and long-term disability worldwide [1]. It is estimated that 750,000 new strokes occur annually in the USA, resulting in 150,000-200,000 deaths. There are two major types of stroke: ischemic and hemorrhagic stroke. Ischemic strokes, which include cryptogenic, lacunae and thromboembolic strokes, are caused by obstruction of blood flow to an area of the brain and account for 87% of all strokes [2]. Hemorrhagic strokes, which account for the remaining 13% of all strokes, are due to a lack of blood flow to an area of the brain that is triggered by a rupture or break in blood vessels [2]. Because ischemic strokes account for most of all strokes, the diagnosis and medical treatment of strokes have focused predominantly on ischemic stroke.Ischemic stroke is a multifactorial disease. Risk factors for ischemic stroke include diabetes, atherosclerosis and hypertension. However, some patients with ischemic stroke have little or no risk factors. Thrombolytic therapy is currently the only approved acute treatment for © 2014 Informa UK Ltd * Author for correspondence: Tel.: +1 773 702 8950, Fax: +1 773 702 1385, jliao@medicine.bsd.uchicago.edu. Financial & competing interests disclosureThe authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Au...

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Time Course of Platelet Activation and von Willebrand Factor in Patients With Non-Valvular Atrial Fibrillation After Ischemic Stroke Evaluation of Prognostic Determinants

Cited by 15 publications

References 31 publications

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Towards the identification of blood biomarkers for acute stroke in humans: a comprehensive systematic review

Plasma levels of von Willebrand factor in the etiologic subtypes of ischemic stroke

Potential serum biomarkers in the pathophysiological processes of stroke

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