Changes in coagulation and fibrinolysis markers in acute ischemic stroke treated with recombinant tissue plasminogen activator

Background and Purpose-Shifts of the balance between coagulation and fibrin olysis play a crucial role in pathogenesis and treatment of cerebral ischem ia. In this study, we characterized the kinetics of hemostatic abnormalitie s induced by acute ischemic stroke and its thrombolytic (recombinant tissue plasminogen activator [rtPA]) or anticoagulant (heparin) treatment. Methods-Systemic generation of molecular markers of hemostasis (fibrin mono mer, D-dimer, thrombin-antithrombin complex, and fibrinopeptide 1.2) was mo nitored in acute ischemic stroke, and the effects of thrombolytic and antic oagulant treatments were analyzed. Results-Thrombolysis with rtPA induced a massive response of markers of coa gulation activation and fibrin formation that peaked after 1 to 3 hours and persisted for up to 72 hours. In contrast, only minor hemostatic changes w ere induced by acute ischemic stroke itself. Administration of heparin did not significantly affect these hemostatic abnormalities. Conclusions-This first characterization of the coagulation activation induc ed by rtPA treatment for acute ischemic stroke and the failure to abolish s uch hemostatic abnormalities by heparin may be of value for further refinem ent of the currently discussed thrombolytic therapy and the controversial a djunctive anticoagulant prophylaxis in stroke patients.