COAGULATION ABNORMALITIES IN LACUNAR AND CORTICAL ISCHEMIC STROKE AREQUITE DIFFERENT

In order to clarify the coagulation profile accompanying ischemic stro ke, which may have implications on therapeutic strategies, we performe d a prospective study to evaluate the hemostatic parameters in the fir st 24 h after the onset of cortical atherothrombotic infarct and lacun ar infarction. Twenty-seven patients with cortical atherothrombotic in farction and 27 patients with lacunar infarction, diagnosed on clinica l and CT-scan criteria, had blood samples taken within the first 24h a fter onset of the stroke, and before anticoagulant treatment had been started. Levels of fibrinogen, von Willebrand factor, D-dimers, prothr ombin factors 1+2, anti-thrombin ill, and C-protein and S-proteins, we re measured. Laboratory tests detected the following abnormalities: a protein C deficiency was observed in 1 case of cortical infarction and in I case of lacunar infarction; a decrease in S-protein was observed in 1 case of cortical infarction, and the presence of lupus anticoagu lant in 4 cases (2 in cortical and 2 in lacunar infarction). Various d egrees of coagulation activation were observed Statistically significa nt activation of the coagulation was observed in the patients with cor tical infarction, compared to normal patients adjusted for age: the le vels of DDI were significantly raised (2298+/-2227 ngml(-1) vs. 750+/- 400 ng ml(-1)) (p < 0.03) as were F1+2 levels (3.9+/-2.8 nmol l(-1) vs . 1.5+/-0.9 nmol l(-1)) (p < 0.01). In the lacunar infarction group, t here was a significant rise in F1+2 compared with normal patients adju sted for age (2.2+/-7.7nmoll(-1) vs. 1.5+/-0.9 nmoll(-1)) (p < 0.01), while the DDI level was in the normal range, when age was taken into a ccount In the cortical infarction group, we observed a significantly r aised fibrinogen level (4.8+/-1.7gl(-1) vs. 3.7+/-1.0gl(-1)) (p<0.05) and von Willebrand factor level (271+/-104% vs. 178+/-103%) (p<0.01) c ompared to the lacunar infarction group. In addition, we observed a si gnificantly low level of S-protein in the cortical infarction group (1 05+/-29%) compared to the lacunar infarction group (127+/-28%) (p < 0. 01). Confirmation of the role of enhanced thrombin activity in the pat hogenesis of acute stroke may be an important determinant in its thera peutic management.