Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Cerebrovasc Dis. 2010;29(1):82-6. doi: 10.1159/000256652. Epub 2009 Nov 10.
Early classification of ischemic stroke subtype is important for secondary stroke prevention and may guide further investigations.
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.
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%.
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.
早期对缺血性脑卒中亚型进行分类对二级预防很重要，并且可能有助于进一步检查。
对 98 例首次急性缺血性脑卒中患者进行了凝血激活[纤维蛋白肽 A（FPA）、凝血酶原片段 1+2（F1+2）、凝血酶-抗凝血酶复合物（TAT）]和纤维蛋白溶解激活[纤溶酶-α2-抗纤溶酶复合物（PAP）、D-二聚体]标志物的检测。这些患者均在症状发作后 12 小时内入院。
中位年龄为 67 岁，44%为女性。从症状发作到采血的中位时间为 4 小时。脑卒中亚型分类为“心源性”（54%）、“大动脉粥样硬化”（11%）、“小血管疾病”（5%）、“其他确定”（9%）或“病因不确定”（20%）。心源性脑卒中患者比其他脑卒中病因患者更常患有冠状动脉疾病（40%比 22%，p = 0.019）。两组在年龄、性别、脑卒中严重程度、采血时间、高血压、糖尿病或当前吸烟频率方面无差异。心源性脑卒中患者的 D-二聚体（中位数）高于其他病因患者（615 比 322μg/l，p < 0.001）。F1+2、FPA、TAT 或 PAP 水平无差异。多变量分析后，较高的 D-二聚体水平与心源性脑卒中独立相关（p = 0.022）。当在 6 小时内测量时，D-二聚体低于 300μg/l 可排除心源性脑卒中，敏感性为 100%，特异性为 52%。
在最初的几个小时内，D-二聚体水平较低提示不太可能为心源性脑卒中，这可能有助于进一步检查。其他凝血标志物对区分不同的脑卒中病因没有帮助。
