Hemostatic molecular markers in acute ischemic stroke-Differences between various subtypes of atherothrombotic infarction-:Differences between various subtypes of atherothrombotic infarction
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It has been postulated that hemostatic molecular markers become increased in acute ischemic stroke. For example, TAT and D-dimer, which are indices of coagulation and fibrinolytic activation, are significantly increased in cardioembolic stroke, whereas βTG and PF4, which are indices of platelet activation, are significantly increased in atherothrombotic stroke. No significant changes in hemostatic molecular markers are observed in lacunar stroke. Atherothrombotic stroke involves various stroke mechanisms. However, no systematic investigation of the relationships between the mechanisms of atherothrombotic stroke and hemostatic molecular markers has yet been performed. The present study was therefore designed to examine the levels of hemostatic molecular markers in different subtypes of atherothrombotic stroke.<BR>A total of 237 patients with acute ischemic stroke were investigated within 2 days of onset of stroke. The study group included 95 patients with lacunar stroke, 51 with atherothrombotic stroke, and 91 with cardioembolic stroke. Patients with lacunar stroke were classified into two groups according to infarct size as determined by MRI : (1) small lacuna type (61 patients with MRI lesions of less than 15 mm in diameter), and (2) giant lacuna type (34 with MRI lesions of 15 mm or more). Atherothrombotic stroke patients were classified into two stroke subtypes besed on the stroke mechanisms : (1) 15 patients with artery to artery embolism, and (2) 36 with non-artery to artery embolism. The hemostatic molecular markers were measured within 2 days of onset.<BR>The plasma levels of TAT and D-dimer were significantly higher in the cardioembolic stroke patients than in the atherothrombotic stroke and lacunar stroke patients (p<0.005 and p<0.0001, respectively). The plasma levels of TAT, D-dimer, βTG and PF4 in the lacunar stroke patients were significantly higher in patients with giant lacunae than in those with small lacunae (p<0.05). Among the atherothrombotic stroke patients, the plasma levels of TAT and PF4 were higher in artery to artery embolism patients than in nonartery to artery embolism patients, the plasma levels of D-dimer and βTG displayed no significant differences among the subtypes of atherothrombotic stroke patients.<BR>Our results suggest that different mechanisms of coagulation may underlie the different subtypes of atherothrombotic stroke. Anticoagulation therapy could be recommended for artery to artery embolism as well as cardioembolic embolism. In lacunar infarcts, coagulation and platelet activation differed between small lacuna infarcts and giant lacuna infarcts. Coagulation and platelet activation were significantly increased in giant lacuna infarcts, suggesting that combination therapy involving antiplatelet and anticoagulation should be considered in the treatment of giant lacuna infarcts.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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