Alterations of platelet, coagulation, and fibrinolysis markers in patientswith acute ischemic stroke

Alterations of platelet, coagulation, and fibrinolysis markers were investi gated to determine the indications for antithrombotic therapy in patients w ith different clinical categories of acute cerebral infarction. Marked plat elet activation was observed in platelet function tests, including measurem ents of platelet-specific proteins and platelet survival, platelet scintigr aphy in the brain, and platelet fibrinogen binding assay, in patients with atherothrombotic stroke. Among patients with atherothrombotic stroke, incre ases of thrombin-antithrombin III complex (TAT) and D-dimer were frequent i n addition to the findings of platelet activation in patients showing progr essing stroke. Patients with cardioembolic stroke demonstrated marked eleva tion of coagulation markers, TAT and fibrinopeptide A, and fibrinolysis mar kers, D-dimer and plasmin-alpha(2)-plasmin inhibitor complex, as well as pl atelet activation. In contrast, neither activation was seen in patients wit h lacunar stroke. On the basis of these findings, antiplatelet therapy is i ndicated for stable or improving stroke, whereas anticoagulant therapy is i ndicated for progressing stroke among patients with atherothrombotic stroke . In patients with cardioembolic stroke, anticoagulant therapy should be st arted as soon as possible, or should be followed by thrombolytic therapy in the hyperacute phase. However, further investigation appears necessary for recommendations for patients with lacunar stroke.