(Stroke. 1996;27:1296-1300.)
© 1996 American Heart Association, Inc.
Articles |
Hemostatic Markers in Acute Ischemic Stroke
Association With Stroke Type, Severity, and Outcome
the Department of Neurology (W.M.F., L.P.E., D.B.) and the Division of Biostatistics, Arizona Cancer Center (J.K.), University of Arizona Health Sciences Center, Tucson.
Correspondence to William M. Feinberg, MD, Department of Neurology, Arizona Health Sciences Center, Tucson, AZ 85724. E-mail feinberg@u.arizona.edu.
Background and Purpose Hemostatic markers can identify activation of the coagulation system in stroke patients. We evaluated whether the levels of these markers at the time of stroke are correlated with stroke severity, type, or mortality.
Methods We measured fibrinopeptide A, cross-linked D-dimer, and ß-thromboglobulin in 70 patients within 1 week of stroke. We examined the association between the level of each of these markers and survival. We adjusted for the possible confounding effect of age, stroke type, or stroke severity using a multivariate Cox proportional hazards model.
Results The median follow-up was 1.22 years. Fourteen patients died during follow-up. Univariate survival analysis identified age (hazard ratio, 1.06; 95% confidence interval [CI], 1.00 to 1.12), stroke type (hazard ratio, 4.44; 95% CI, 1.29 to 15.23), initial Toronto Stroke Scale score (hazard ratio, 5.05; 95% CI, 2.08 to 12.27), cross-linked D-dimer (hazard ratio, 6.43; 95% CI, 2.83 to 14.62), fibrinopeptide A (hazard ratio, 2.14; 95% CI, 1.26 to 3.63), and ß-thromboglobulin (hazard ratio, 7.63; 95% CI, 2.22 to 26.28) as significantly associated with mortality. In a multivariate model, initial stroke severity and each of the hemostatic markers were independently associated with subsequent mortality.
Conclusions Elevated hemostatic markers after acute ischemic stroke identify patients with increased risk for mortality. This association appears to be independent of stroke severity or stroke type.
Key Words: cerebral infarction • fibrin fibrinogen degradation products • thrombosis • platelet activation • prognosis
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