Hemostatic activation in acute ischemic stroke

Background and Purpose: The purpose of this study was to examine the associ ation between hemostatic activation and stroke severity, and to provide dat a on hemostatic variables in acute ischemic stroke. Methods: The patient ma terial comprised 76 consecutive patients with acute ischemic stroke (median 16 h, interquartile range 3-48). Levels of hemostatic variables were deter mined in blood samples collected on the day of hospitalization. Stroke seve rity was assessed on admission by the Oxfordshire Community Stroke Project (OCSP) classification, and on discharge (median 9 days, interquartile range 6-14) by Barthel Index (BI, scores 0-50, 55-90, or 95-100) and modified Ra nkin Scale (mRS, scores 0-1 or 2-6). Associations were assessed by multiple linear regression analyses. Results: Levels of the fibrin degradation prod uct D-Dimer and the activation peptide prothrombin fragment 1+2 (F1+2) were linearly related to stroke severity, whether assessed on admission (P=.001 and .03, respectively, for the OCSP classification), or on discharge (P=.0 09 and .43, respectively, for BI; and .001 and .05, respectively, for mRS). High levels of D-Dimer and F1+2, as well as low levels of antithrombin and protein C were also present in patients with a presumed embolic source, an d low antithrombin or protein C was borderline significantly associated wit h atrial fibrillation (P=.072 and .058, respectively). Low levels of protei n C or protein S, and the presence of antiphospholipid antibodies, includin g lupus anticoagulant (LA), was detected in 13/73 (18%) and 15/70 (21%) of the patients, respectively. Conclusion: Activation of the hemostatic system is independently related to acute stroke severity and short-term outcome. Low levels of coagulation inhibitors or presence of antiphospholipid antibo dies is a relatively frequent finding in unselected patients with acute isc hemic stroke, but a causative role cannot be inferred from our study. (C) 2 001 Elsevier Science Ltd. All rights reserved.