on February 26, 2004
Published online before print February 26, 2004, doi: 10.1161/01.STR.0000119382.25543.2A
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Submitted on November 27, 2003
From the Department of Medicine, Skellefteå County Hospital, Skellefteå (L.J., J.-H.J., K.B.); Department of Public Health and Clinical Medicine (B.S., G.H.) and Medical Bank (G.H.), Umeå University Hospital, Umeå; and Department of Clinical Chemistry, Örebro University Hospital and Division of Biomedicine, Örebro University, Örebro (T.K.N.), Sweden. * To whom correspondence should be addressed. E-mail: lars.johansson.ss{at}vll.se.
Background and Purpose--Abnormalities in the hemostatic system may cause hemorrhagic complications. The aim of the present study was to examine whether total concentrations of tissue plasminogen activator (tPA), plasminogen inhibitor-1 (PAI-1), tPA/PAI-1 complex, von Willebrand factor (VWF), and soluble thrombomodulin were associated with a first-ever intracerebral hemorrhage (ICH). Methods--This prospective study was an incident case-referent study nested within the Västerbotten Intervention Program and the Northern Sweden Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) cohorts. By 2000, Results--The average time from screening to the ICH event was 5.1 years. tPA/PAI-1 complex, systolic and diastolic blood pressures, and hypertension were associated with ICH in the univariate analysis. In the multivariate model, only hypertension (odds ratio [OR], 3.96; 95% confidence interval [CI], 1.27 to 12.36) and the tertile with the highest level of VWF compared with the lowest tertile (OR, 0.27; 95% CI, 0.08 to 0.90) were independently associated with ICH. The OR for the combined exposure to hypertension and low levels of VWF was 8.95, indicating a possible synergistic interaction. No associations were observed for smoking, cholesterol, body mass index, PAI-1, tPA, and soluble thrombomodulin. Conclusions--This study showed that hypertension and low concentrations of VWF were independently associated with ICH. Furthermore, we observed a possible synergistic interaction between low levels of VWF and hypertension, suggesting 2 different pathways in the development of ICH.
Accepted on December 10, 2003
Hemostatic Factors as Risk Markers for Intracerebral Hemorrhage. A Prospective Incident Case-Referent Study
Lars Johansson MD, PhD*;
74 000 subjects had been screened, and 39 ICH cases were defined according to the World Health Organization MONICA criteria. A total of 78 matched controls were selected from the same cohort.
Key words: cerebral hemorrhage • fibrinolysis • risk factors • thrombomodulin • von Willebrand factor
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