PROGNOSTIC SIGNIFICANCE OF HAEMOSTATIC VARIABLES IN ACUTE STROKE

 

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Acute stroke is normally the result of thromboembolism. Such thromboemboli form and extend by the interaction of platelets and fibrin and elicit a fibrinolytic response. Hence laboratory indices of platelet activation, thrombin formation and plasmin formation may be related to thrombus size and progression, and hence to clinical outcome, ie disability and death. We studied 100 patients with acute paretic stroke and followed them for 1 year. Plasma levels of betathromboglobulin (BTG), fibrinogen, fibrinopeptide A (FPA), fibrin(ogen) fragment BB15-42, serum fragment E, high molecular weight cross-linked fibrin degradation products (X-L FDP) D-dimer, total and tissue plasminogen activator activity, tissue plasminogen activator inhibition and serum fibrin(ogen) degradation products (FDP) were related to death and functional recovery in the 1 year follow up period. The levels of BTG, fibrinogen, FPA, BB15-42, tissue plasminogen activator inhibition and serum fragment E were significantly higher on the first day following stroke, in patients who subsequently died within 1 year when compared to patients who survived. Lowered levels of fibrin plate lysis area as well as raised tPA activity, X-L FDP and D-dimer levels did not achieve significance in patients who subsequently died. In the patients who survived only increased BB15-42 and X-L FDP levels were predictive of functional dependence when compared to patients who became independent. Increased fibrinogen, FPA and fibrin plate lysis area, fragment E and tPA activity and reduced D-dimer did not achieve significance in patients with greater disability when compared to patients with minimal disability. We conclude that several measures of activation of haemostasis are predictive of death in the year following stroke, but only BB15-42 and X-L FDP predict disability in survivors.