Activation of thrombosis and fibrinolysis following brain infarction

To clarify the sequence of alterations in the thrombotic and fibrinolytic s ystems after acute brain infarction, we prospectively examined sequential c hanges in coagulatory markers in 38 patients suffering from cardioembolic i nfarcts (CEI), 41 patients with atherothrombotic infarcts (ATI), 58 patient s with lacunar infarcts (LI), and 32 age-matched controls. The plasma level of thrombin-antithrombin III complex (TAT), fibrinopeptide A (FpA), D-dime r, fibrin degradation products-E (FDP-E), fibrinogen, alpha2-plasmin inhibi tor-plasmin complex (PIC), and percent activity of antithrombin III (AT-III ) were measured within 48 h, at 1 week, and at 3 weeks after the stroke ons et. Significantly elevated levels of TAT and FpA, which are both markers of thrombin formation, were observed in CEI patients, and these elevated leve ls were associated with increasing D-dimer levels for 3 weeks (P < 0.0001). D-Dimer in CEI patients was significantly elevated compared to control, LI and ATI levels within 48 h (P < 0.001). Percent activity of AT-m was signi ficantly decreased in CEI patients for 3 weeks compared to this activity in controls, LI and ATI (P < 0.001). TAT and FpA also increased significantly within 38 h in ATI subjects and declined thereafter. A significant elevati on of FDP-E (P < 0.001) and D-dimer (P < 0.05, P < 0.01) was detected in pa rallel with increasing fibrinogen for 3 weeks. However, there was no signif icant depletion of percent activity of AT-III in ATI. In LI subjects, no si gnificant elevation of TAT, D-dimer or EDP-E were observed within 1 week. P IC increased significantly in three subtypes of brain infarcts, but did not differ significantly among the three subtypes for 3 weeks. An accurate ass essment of sequential alterations in thrombotic and fibrinolytic markers in the acute stage of brain infarct should contribute to the clinical diagnos is of brain infarct subtype. Alterations in these markers in response to ac tivation of the coagulatory system are attributable to the different pathog enesis of ischemic stroke. (C) 2000 Elsevier Science B.V. All rights reserv ed.