Turgut Nilda, Akdemir Osman, Turgut Burhan, Demir Muzaffer, Ekuklu Galip, Vural Ozden, Ozbay Gültaç, Utku Ufuk
Department of Neurology, Trakya University School of Medicine, Edirne, Turkey.
Clin Appl Thromb Hemost. 2006 Jan;12(1):15-20. doi: 10.1177/107602960601200104.
The coagulation system is activated and coagulation activation markers are elevated in acute ischemic stroke with nonvalvular atrial fibrillation (NVAF). The etiology, severity, and prognosis of the ischemic stroke might be estimated with the level of the activation of the coagulation system. In this study, prothrombin F1+2 (F1+2), D-dimer, and fibrinogen levels were measured in patients with acute ischemic stroke with and without NVAF, and stroke severity was compared with these hemostatic parameters. Of 55 patients, 29 had sinus rhythm (group I), 26 had NVAF (group II); 20 healthy subjects (group III) were included in the study. Subtypes of cerebral infarction were classified. The patients underwent stroke severity, electrocardiography, echocardiography, cranial computed tomography, cervical duplex ultrasonography, and hemostatic parameter studies. In group II, F1+2 level (2.83+/-0.89) was significantly higher than in group I (2.33+/-0.80) and III (1.94+/-0.64) (p values: group I-II, 0.036; groups II-III, 0.001; groups I-III, 0.104). In group III, fibrinogen level (251.64+/-60.96) was significantly lower than that in groups I (347.97+/-111.49) and II (364.04+/-86.20) (p=0.001). D-dimer was not significantly different between groups. In group I, lacunar syndrome (LACS), and in group II, partial and total anterior circulation syndrome (PACS+TACS) were more common (p=0.013, p=0.001, respectively). In group II, Scandinavian Stroke Scale scores were lower than those in group I (group I=45.2+/-14, group II=35.4+/-18.9, p=0.02). In conclusion, activation of coagulation, demonstrated by increment F1+2, is more abundant in the stroke patients with NVAF than in the stroke patients with sinus rhythm. Our results also showed that activation of the hemostatic system might be related to stroke subtype and stroke severity. It is suggested that the oral anticoagulation treatment as prophylaxis is important in the prevention of stroke in patients with NVAF.
在伴有非瓣膜性心房颤动（NVAF）的急性缺血性卒中患者中，凝血系统被激活，凝血激活标志物升高。缺血性卒中的病因、严重程度及预后可通过凝血系统的激活水平来评估。在本研究中，对伴有和不伴有NVAF的急性缺血性卒中患者测定了凝血酶原F1+2（F1+2）、D-二聚体及纤维蛋白原水平，并将卒中严重程度与这些止血参数进行比较。55例患者中，29例为窦性心律（I组），26例为NVAF（II组）；纳入20名健康受试者作为III组。对脑梗死亚型进行分类。患者接受了卒中严重程度、心电图、超声心动图、头颅计算机断层扫描、颈部双功超声及止血参数检查。II组的F1+2水平（2.83±0.89）显著高于I组（2.33±0.80）和III组（1.94±0.64）（p值：I-II组，0.036；II-III组，0.001；I-III组，0.104）。III组的纤维蛋白原水平（251.64±60.96）显著低于I组（347.97±111.49）和II组（364.04±86.20）（p=0.001）。D-二聚体在各组间无显著差异。I组中腔隙综合征（LACS）较为常见，II组中部分性和完全性前循环综合征（PACS+TACS）较为常见（p值分别为0.013和0.001）。II组的斯堪的纳维亚卒中量表评分低于I组（I组=45.2±14，II组=35.4±18.9，p=0.02）。总之，F1+2升高所显示的凝血激活在伴有NVAF的卒中患者中比伴有窦性心律的卒中患者更为明显。我们的结果还表明，止血系统的激活可能与卒中型别及卒中严重程度有关。提示口服抗凝治疗作为预防措施对于NVAF患者预防卒中很重要。
