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Stroke, Vol 24, 1496-1500, Copyright © 1993 by American Heart Association

ARTICLES

Early prognostic factors in ischemic stroke. The role of protein C and protein S

GP Anzola, M Magoni, E Ascari and V Maffi
Clinica Neurologica, Universita di Brescia, Italy.

BACKGROUND AND PURPOSE: Protein C and protein S have been found reduced in some patients with ischemic cerebrovascular diseases, but the relevance of this finding for prognosis is unsettled. METHODS: In 43 consecutive patients admitted over 6 months for acute ischemic stroke, protein C and free protein S were evaluated on admission, and at 2 and 6 months after stroke. Excluded were all patients with known causes liable to reduce the levels of protein C, free protein S, or both. RESULTS: In 14% of patients, abnormally low levels of protein C were found at entry. In comparison to the remaining sample, this group had a significantly lower initial score on the Barthel and Canadian neurological scales, a higher prevalence of emboligenic cardiac diseases, and had a higher mortality at 6 months. No statistical difference was found for the other vascular risk factors. Eight patients (18.4%) had abnormally low levels of free protein S at entry. In comparison to the remaining sample, there was no statistical difference in the severity scores, prevalence of emboligenic cardiac diseases, mortality, or vascular risk factors. CONCLUSIONS: These findings suggest that low levels of protein C in the acute stroke reflect the massive activation of coagulation factors and are predictive of adverse outcome, whereas the significance of low levels of free protein S remains to be clarified.

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