Detection of prothrombotic state in ischemic stroke by monitoring plasma molecular markers

The feasibility of using recently developed coagulation-fibrinolysis markers to detect hemostatic alteration in acute ischemic stroke was examined to see whether they may be employed as predictors of recurrence. We measured serially the plasma thrombin-antithrombin III complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC) and D-dimer in patients with ischemic stroke (53 acute, 102 chronic) and 37 normal control subjects. In the acute stage, TAT and D-dimer were significantly increased in both atherothrombotic and lacunar stroke. In cardioembolic stroke, TAT, PIC, and cross-linked D-dimer (D-dimer) were more significantly increased and reached a peak within 3 days (TAT) or at around the second week (PIC, D-dimer) poststroke. TAT, PIC, and D-dimer correlated with infarct size, but TAT and D-dimer were significantly increased even in patients with small infarcts. In the chronic stage, TAT was increased above the mean + 2 SD in 7 patients with cardioembolic stroke (n = 17), in 13 with atherothrombotic stroke (n = 37), and in 11 with lacunar stroke (n = 48). In those we had examined within 4 months before recurrence, TAT was increased above the mean + 2 SD in 7 patients (n = 8). We demonstrated TAT and D-dimer to be highly sensitive detectors of hemostatic alteration in small ischemic stroke, contrary to previous reports, and also showed that TAT can detect the prothrombotic state before recurrence.