Titre
D-dimers predict stroke subtype when assessed early.
Type
article
Institution
Externe
Périodique
Auteur(s)
Isenegger, J.
Auteure/Auteur
Meier, N.
Auteure/Auteur
Lämmle, B.
Auteure/Auteur
Alberio, L.
Auteure/Auteur
Fischer, U.
Auteure/Auteur
Nedeltchev, K.
Auteure/Auteur
Gralla, J.
Auteure/Auteur
Kohler, H.P.
Auteure/Auteur
Mattle, H.P.
Auteure/Auteur
Arnold, M.
Auteure/Auteur
Liens vers les personnes
ISSN
1421-9786
Statut éditorial
Publié
Date de publication
2010
Volume
29
Numéro
1
Première page
82
Dernière page/numéro d’article
86
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
BACKGROUND: Early classification of ischemic stroke subtype is important for secondary stroke prevention and may guide further investigations.
METHODS: Levels of coagulation activation [fibrinopeptide A (FPA), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT)] and fibrinolysis activation [plasmin-alpha(2)-antiplasmin complex (PAP), D-dimers] markers were measured in 98 consecutive patients with a first-ever acute ischemic stroke admitted within 12 h after symptom onset.
RESULTS: Median age was 67 years and 44% were women. Median time from symptom onset to blood sampling was 4 h. Stroke subtype was classified as 'cardioembolic' (54%), 'large-artery atherosclerosis' (11%), 'small-vessel disease' (5%), 'other determined' (9%) or 'undetermined etiology' (20%). Patients with cardioembolic stroke suffered more often from coronary artery disease than patients with other stroke etiologies (40 vs. 22%, p = 0.019). There were no differences in age, sex, stroke severity, time to blood sampling, frequency of hypertension, diabetes mellitus or current smoking. D-dimers (medians) were higher in patients with cardioembolic strokes than in those with other etiologies (615 vs. 322 microg/l, p < 0.001). No differences in F1+2, FPA, TAT or PAP levels were found. After multivariate analysis, higher D-dimer levels remained independently associated with cardioembolic stroke (p = 0.022). When measured within 6 h, D-dimers below 300 microg/l excluded cardioembolic stroke with a sensitivity of 100% and a specificity of 52%.
CONCLUSIONS: Low D-dimer levels in the first few hours make a cardioembolic stroke unlikely, and may be useful to guide further investigations. Other coagulation markers were not useful in differentiating between different stroke etiologies.
METHODS: Levels of coagulation activation [fibrinopeptide A (FPA), prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT)] and fibrinolysis activation [plasmin-alpha(2)-antiplasmin complex (PAP), D-dimers] markers were measured in 98 consecutive patients with a first-ever acute ischemic stroke admitted within 12 h after symptom onset.
RESULTS: Median age was 67 years and 44% were women. Median time from symptom onset to blood sampling was 4 h. Stroke subtype was classified as 'cardioembolic' (54%), 'large-artery atherosclerosis' (11%), 'small-vessel disease' (5%), 'other determined' (9%) or 'undetermined etiology' (20%). Patients with cardioembolic stroke suffered more often from coronary artery disease than patients with other stroke etiologies (40 vs. 22%, p = 0.019). There were no differences in age, sex, stroke severity, time to blood sampling, frequency of hypertension, diabetes mellitus or current smoking. D-dimers (medians) were higher in patients with cardioembolic strokes than in those with other etiologies (615 vs. 322 microg/l, p < 0.001). No differences in F1+2, FPA, TAT or PAP levels were found. After multivariate analysis, higher D-dimer levels remained independently associated with cardioembolic stroke (p = 0.022). When measured within 6 h, D-dimers below 300 microg/l excluded cardioembolic stroke with a sensitivity of 100% and a specificity of 52%.
CONCLUSIONS: Low D-dimer levels in the first few hours make a cardioembolic stroke unlikely, and may be useful to guide further investigations. Other coagulation markers were not useful in differentiating between different stroke etiologies.
Sujets
PID Serval
serval:BIB_245CD898A95D
PMID
Date de création
2015-02-10T08:49:07.572Z
Date de création dans IRIS
2025-05-20T20:05:18Z