Lipoprotein(a), other lipoproteins and hemostatic profiles in patients with ischemic stroke: The relation to cardiogenic embolism

Lipoprotein and hemostatic profiles including coagulation inhibitors were d etermined in 136 patients with acute ischemic stroke. Based on clinical exa mination, cerebral computed tomography, Doppler ultrasonography of precereb ral arteries and transthoracic echocardiography, the strokes were classifie d as cardioembolic (n = 38), non-cardioembolic (n = 92), and mixed cardioem bolic/hypertensive (n = 6). Patients with cardioembolic stroke were older t han patients with non-cardioembolic stroke. Lipoprotein(a) was higher in th e cardioembolic than in the non-cardioembolic group. Lipoprotein(a) was not significantly correlated to the other lipid levels and may represent an in dependent lipid risk factor. The non-cardioembolic group had higher levels of total cholesterol, triglycerides, total cholesterol/high-density lipopro tein cholesterol ratio, low-density lipoprotein cholesterol, apolipoprotein Al, and apolipoprotein B. The cardioembolic group had higher concentration s of fibrinogen and D-dimer, and lower levels of antithrombin, protein C, p rotein S and heparin cofactor 2 than the non-cardioembolic group. The diffe rences in the hemostatic profile are consistent with thrombosis due to acti vated coagulation being more involved in the pathogenesis of cardioembolic than of non-cardioembolic stroke. Lipoprotein(a) seems to be more associate d with coagulation markers of thrombosis than with atherosclerosis, whereas the other lipids mainly seem to be risk factors for atherosclerosis. Copyr ight (C) 2000 S. Karger AG, Basel.