This Article Full Text Full Text (PDF) All Versions of this Article: 35/8/1946    most recent 01.STR.0000133340.37712.9bv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Olivot, J.-M. Search for Related Content PubMed PubMed Citation Articles by Olivot, J.-M. Related Collections Epidemiology Endothelium/vascular type/nitric oxide Risk Factors for Stroke

(Stroke. 2004;35:1946.)
© 2004 American Heart Association, Inc.

Original Contributions

Soluble Thrombomodulin and Brain Infarction

Case-Control and Prospective Study

Jean-Marc Olivot, MD; Julien Labreuche, BST; Martine Aiach, PhD Pierre Amarenco, MD for the GENIC Investigators

From the Department of Neurology and Stroke Centre (J.-M.O., J.L., P.A.), Bichat University Hospital and Medical School, Denis Diderot University-Paris VII; and the Department of Haematology and Haemostasis (J.-M.O., M.A.), Georges Pompidou Hospital, and INSERM 428, René Descartes University, Paris, France.

Correspondence to Professor Pierre Amarenco, Department of Neurology and Stroke Centre, Bichat University Hospital and Medical School, 46 rue Henri Huchard, 75018 Paris, France. E-mail pierre.amarenco{at}bch.ap-hop-paris.fr

Background and Purpose— Increased soluble thrombomodulin (sTM) concentration has been associated with recurrent coronary events, whereas in one prospective study it predicted fewer first-ever coronary events. One study found no relationship between brain infarction (BI) and sTM levels. Among all subjects of the Étude du Profil Génétique de l’Infarctus Cérébral (GENIC) cohort and those free of previous vascular history, we investigated the relationship between sTM level and BI risk, and among cases, its relationship with BI prognosis.

Methods— Patients with BI (n=492) were consecutively recruited from 12 centers. Hospital controls without a history of stroke (n=492) were individually matched for age, sex, and center. Blood samples were collected after hospitalization. Determination of sTM levels was centralized in a single laboratory.

Results— Soluble TM concentration significantly increased with age and hypertensive status, but was similar in cases and controls. With analyses restricted to 278 pairs of subjects with no previous vascular history, sTM concentration >59.6 µg/L (second and third tertiles compared with the first) was associated with fewer first-ever BI (adjusted odds ratio of 0.56 (95% CI, 0.35 to 0.89; P=0.014). Among the cases, increased sTM concentration was associated with a higher death rate after a median follow-up of 5.2 (1.4 to 6.4) years. The adjusted hazard ratio per 1 SD of sTM concentration increase (34.2 µg/L) was 1.19 (95% CI, 1.02 to 1.39; P=0.028).

Conclusions— Increased sTM concentration may be protective against BI in subjects with no previous vascular disease, whereas it may predict a fatal outcome in patients who have already had a BI. Consequently, sTM levels should be interpreted according to vascular history.

Key Words: brain infarction • thrombomodulin • epidemiology • prognosis • risk factors

This article has been cited by other articles:

				D. Tanne, R. F. Macko, Y. Lin, B. C. Tilley, S. R. Levine, and for the NINDS rtPA Stroke Study Group Hemostatic Activation and Outcome After Recombinant Tissue Plasminogen Activator Therapy for Acute Ischemic Stroke Stroke, July 1, 2006; 37(7): 1798 - 1804. [Abstract] [Full Text] [PDF]