Stroke, Vol 25, 278-281, Copyright © 1994 by American Heart Association
F van Kooten, G Ciabattoni, C Patrono, PI Schmitz, J van Gijn and PJ Koudstaal
BACKGROUND AND PURPOSE: Enhanced thromboxane biosynthesis has previously
been reported in patients with acute ischemic stroke. In this study we
examined the time course of thromboxane biosynthesis after the onset of
symptoms in 13 patients with acute cerebral infarction. METHODS: We
obtained five to eight consecutive 6-hour urine samples from each of these
13 patients within the first 48 hours after onset of symptoms to study the
dynamics of platelet activation in this setting. The urinary excretion of
the major enzymatic metabolite of thromboxane B2, 11-dehydro-thromboxane
B2, was measured by a previously validated radioimmunoassay. The excretion
rate was compared with that of 20 control patients with nonvascular
neurological diseases. RESULTS: Eleven patients (85%) had at least one
value exceeding 2 SD of the control mean (251 pmol/mmol creatinine). The
proportion of samples with an elevated 11-dehydro-thromboxane B2 level was
markedly similar in each of the eight 6-hour collection periods (mean, 52
+/- 8%; range, 40% to 67%). In 4 patients (31%) the excretion rate was
elevated in all measurements obtained. In the 11 patients with enhanced
thromboxane biosynthesis, no uniform pattern of changes over time in
metabolite excretion emerged, with 3 patients having peak values at 0 to 12
hours, 3 at 12 to 24 hours, 3 at 24 to 36 hours, and 2 at 36 to 48 hours.
The level and dynamics of 11-dehydro-thromboxane B2 excretion were related
neither to the neurological symptoms nor to the type or site of the
cerebral ischemia. CONCLUSIONS: We conclude that episodes of platelet
activation occur repeatedly during the first 48 hours after the onset of
symptoms of an acute ischemic stroke. Given its apparent dynamic nature,
this ongoing process may be amenable to pharmacologic modulation.
ARTICLES
Evidence for episodic platelet activation in acute ischemic stroke
Department of Neurology, University Hospital Rotterdam, The Netherlands.
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