Coagulation Activation Markers Associate with Early Neurological Function and Infarct Volume in Acute Ischemic Stroke

The state of the coagulation-fibrinolysis system plays a pivotal role in thrombosis; however, its significance in guiding early revascularization for ischemic stroke remains inadequately understood.

To explore the correlation between coagulation activation markers and early neurological function and infarction volume in acute ischemic stroke (AIS), and to evaluate their predictive value for stroke severity.

This retrospective cohort study enrolled 135 patients with acute ischemic stroke. Participants were stratified into two groups based on admission National Institutes of Health Stroke Scale (NIHSS)scores: mild stroke group (NIHSS≤3, n=95) and moderate-to-severe stroke group (NIHSS>3, n=40). Five coagulation activation markers were quantified: thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), tissue plasminogen activator-inhibitor complex (t-PAIC), and D-dimer. The associations between these biomarkers and stroke severity were evaluated using logistic regression models and receiver-operating characteristic (ROC) curve analyses. Infarct volume and its spatial distribution across distinct brain regions were quantified using dedicated neuroimaging software. Subsequently, the correlation between the five coagulation markers and both total infarct volume and region-specific infarction volumes were assessed.

Plasma levels of TAT, t-PAIC, and D-dimer were significantly elevated in the moderate-to-severe stroke group compared to the mild stroke group (p<0.05). Multivariate logistic regression analysis identified D-dimer as an independent risk factor for moderate-to-severe stroke (OR=1.002,95% CI:1.000-1.004). The area under the curve (AUC) values for TAT, t-PAIC, and D-dimer in predicting moderate-to-severe stroke were 0.62,0.63, and 0.59, respectively. The combined predictive model achieved an AUC of 0.67. Furthermore, within the moderate-to-severe stroke group, TAT levels demonstrated a positive correlation with anterior circulation cortical infarction volume (R=0.61, p<0.05). Additionally, D-dimer levels exhibited positive correlations with both total infarct volume and anterior circulation cortical infarction volume (R=0.74, p<0.05; R=0.79, p<0.05).

TAT, t-PAIC and D-dimer serve as predictors for the severity of acute ischemic stroke, and can be used as a simple and rapid auxiliary tool combined with imaging evaluation to provide synergistic guidance for clinical decision-making.