Persistent hyperfibrinogenemia in acute ischemic stroke / transient ischemic attack (TIA)

2008 ◽  
Vol 99 (01) ◽  
pp. 169-173 ◽  
Author(s):  
Einor Ben Assayag ◽  
Irena Bova ◽  
Ludmila Shopin ◽  
Michael Cohen ◽  
Shlomo Berliner ◽  
...  

SummaryIncreased fibrinogen concentration is a well known phenomenon following acute ischemic stroke. However, the natural course of this hyperfibrinogenemia is uncertain. We aimed to clarify whether it is of a transient or more persistent nature in patients who harbor an underlying morbid biology of atherothrombo-inflammation. Venous blood for fibrinogen measurements was obtained from the control group participants and from stroke patients within 24 hours of admission, as well as 12 months following the acute event. In order to perform a time course analysis, we divided our cohort into tiles of time from symptoms' onset and compared the fibrinogen concentrations usingANOVA. Elevated fibrinogen concentrations were found in stroke patients on admission compared with matched controls (p<0.001).Analysis of variance in the different tertiles of time from symptoms' onset identified that fibrinogen concentrations were already relatively high during the initial phase of the event and did not differ significantly between the tiles (p=0.268). Moreover, when we calculated the absolute differences between the patients' fibrinogen concentrations and that of the matched controls there was clearly a minor increment during the time course from symptoms' onset in the stroke patients group. In conclusion, persistent hyperfibrinogenemia is present in patients with acute ischemic cerebral events and it might be present during the earlier stages of the disease as presently shown. Prompt and longterm, rather than short term, interventions to reduce the concentrations of this protein might therefore be of relevance.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Vicini-Parra ◽  
Jenny Ospina ◽  
Cristian Correa ◽  
Natalia Gomez ◽  
Stephania Bohorquez ◽  
...  

Introduction: A prospective stroke database was implemented as part of a still-growing comprehensive stroke centre (CSC). This CSC is located within a referral public hospital (Hospital Occidente de Kennedy) in Bogota DC, Colombia , that serves 2.3 million people of mainly low economic income. In this abstract, we present the data pertaining patients who were thrombolysed in our institution during the first year of data collection, and specify onset-to-door (OTD) times as they relate to the means of transportation used. Hypothesis: Acute stroke patients who arrive in ambulance have the shortest onset-to-door times. Methods: Printed forms were filled for every patient who arrived with diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA). Data was transcribed to an electronic database (Numbers, Apple Inc.) and analyzed with SPSS Statistics version 23 (IBM Corporation). A retrospective descriptive analysis was performed for central tendency and dispersion measures. Results: Since August 1st 2014 until July 31st 2015, 39 patients (17.7% of AIS patients) were thrombolysed. Mean onset-to-door times are shown in table 1. Prenotification was received for only 1 patient. All patients came from their homes. Conclusions: Almost half of our thrombolysed patients arrived in taxi to our institution. Taxi was the fastest means of transportation, ambulance was the slowest and private cars were in the middle of those. This confirmed our suspicion that the state-owned emergency medical services (SEMD) are suboptimal and that stroke patients prefer to use public transportation rather than SEMD. This should warn public health authorities on he urgent need to improve our SEMD. In the meantime, this finding prompts us to include taxi drivers in our periodic stroke campaigns.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saif Bushnaq ◽  
Atif Zafar ◽  
Kempuraj Duraisamy ◽  
Nudrat Tasneem ◽  
Mohammad M Khan ◽  
...  

Background: Interleukin-37 (IL-37) is a new member of IL-1 cytokine family with a defined role as a negative feedback inhibitor of pro-inflammatory responses. IL-37 has yet to be evaluated in non-immune neurological diseases like ischemic or hemorrhagic stroke. This study aimed to measure the urine and serum IL-37 levels in patients with acute ischemic stroke. Method: Twelve patients consented for the study. Two sets of serum and urine samples were obtained and analyzed; one upon admission to the hospital, and the second the next morning after overnight fasting. The trends in serum level of IL-37 in 5 stroke patients, while trends in urine level of 6 patients were available, measured by real-time polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Prior studies with healthy volunteers as control group have consistently showed IL-37 plasma level around or less than 65 pg/ml with maximum normal levels on ELISA approximated at 130 pg/ml. Results: IL-37 level in urine in stroke patients ranged from 297 - 4467. IL-37 levels were in the range of 300s to 1000s in patients with ischemic stroke compared with reported healthy controls in literature where the level was always less than 90. Three of these 10 patients presented within 3 hours of stroke onset with IL-37 serum levels being 2655 pg/ml, 3517 pg/ml and 5235 pg/ml. In all others, it ranged much less than that, with the trend of delayed presentation giving less IL-37 levels, both in urine and serum. There were no clear differences found in patients with or without tPA, diabetes, hyperlipidemia and high blood pressure in our small study. Conclusion: The study shows a rather stable elevation of IL-37 levels post-ischemic stroke, which if compared to available data from other studies, is 3-10 times elevated after acute ischemic stroke with an uptrend in the first few days. IL-37 plays some role in mediating post-stroke inflammation with significant rise in serum and urine IL-37 levels suggesting a key role of this novel cytokine in post-stroke pathology. This is the first ever reported study measuring and trending IL-37 levels in human plasma after an acute ischemic stroke.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Joancy M Archeval-Lao ◽  
Hope Moser ◽  
Stephen A Riney ◽  
Jorge Kawano-Castillo ◽  
Stephanie A Parker ◽  
...  

Background: Currently, t-PA is the only FDA approved treatment for acute ischemic stroke (AIS). Supplementing t-PA with therapeutic hypothermia is being evaluated, but cooler temperatures may affect the enzymatic activity of t-PA. Thromboelastography (TEG) determines coagulation status in whole blood, and has detected hypercoagulability in AIS patients compared to healthy controls. Using TEG, we evaluated the effect of variable degrees of hypothermia on clot formation and lysis in AIS patients receiving t-PA. Methods: Between June 2012 -July 2013, venous blood from 18 AIS patients receiving t-PA within 4.5 hours of symptom onset was collected prior to and 10 minutes after t-PA bolus. Blood samples were analyzed by TEG at 30°C, 33°C, and 37°C. The variables of interest were R (initiation of clot formation), K (speed of clot strengthening), Angle α (rate of clot formation), and LY30 (percentage of clot lysis over 30 minutes) (see figure). All statistical analyses were performed using SAS 9.3. Results: Baseline R averaged 6.0, 5.6, and 4.6 minutes at 30°C, 33°C, and 37°C (p=0.02),K averaged 2.5, 2.3, and 1.4 (p=0.01),and Angle averaged 59.1, 62.4, and 69.3(p=0.01), indicating slower clotting at lower temperatures. Post t-PA LY30 averaged 93.9, 93.9, 89.8 (p= 0.61, N=18) indicating no effect on t-PA lytic activity at lower temperatures. Conclusions: Our data suggest that hypothermia progressively slows clot formation in AIS patients but has no effect on the lytic effect of t-PA as measured by TEG.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  

Introduction: Although the effect of blood pressure in post-stroke outcome is well recognized, the long-term time course of BP following acute ischemic stroke and it’s influence to outcomes have not been well elucidated. Method: From a multicenter prospective registry of acute ischemic stroke patients, a total of 5,514 patients with measurement of systolic blood pressure (SBP) in more than 2 of 7 prespecified time points up to 1 year after symptom onset were analyzed. The patients were grouped according to longitudinal SBPs of each patient using a group-based trajectory model, and number of groups were determined by the optimal delta-Bayesian Information Criterion. Outcome measures, which were stroke recurrence, mortality and composite of each events along with myocardial infarction were prospectively collected up to 1 year after symptom onset. Results: Patients were categorized into four groups according to their SBP trajectories: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). After adjustment for pre-determined covariates, there were higher risk of stroke recurrence in persistently high SBP group (hazard ratio (HR), 2.28 [95% confidence interval (CI), 1.01-5.12]). Mortality was higher only in the slowly dropping SBP group (HR, 1.50 [95% CI, 1.09-2.05]). Composite events were higher in both persistently high (HR, 1.96 [95% CI, 1.02-3.75]) and slowing dropping (HR, 1.54 [95% CI, 1.18-2.00]) SBP groups. Conclusion: There were a group of patterns in long-term longitudinal SBP changes after acute ischemic stroke. Especially, slow BP droppers might have a distinct nature with higher mortality and would be a target for future investigations.


2021 ◽  
pp. 1-4
Author(s):  
Bharat L. Konin ◽  
Shiney Aggarwal ◽  
Swaraj S. Waddankeri

Background and Purpose: The measurement of markers of inflammation or thrombosis has been proposed as a method to improve the prediction of risk in patients with vascular disease. The role of C-reactive protein (CRP) as a novel plasma marker of atherothrombotic disease is currently under investigation. We related age and gender predilection of plasma CRP levels to first ever ischemic stroke and its role on mortality. Methods: Sixty patients with either hypertension or diabetes or both or none without thrombolysis with first ever acute ischemic stroke patients were examined. CT scan of brain was done after 24 hours of onset of symptoms to confirm the diagnosis. Plasma CRP level was determined after 12 - 72 hours range after the onset of symptoms in all CT confirmed ischemic stroke patients. This clinical study was done during June 2018 to January 2020. CRP was randomly measured in 60 age and sex matched individuals admitted in other wards of the hospital matched in all possible criteria expect the disease under study as a control group. Results: The CRP concentration in ischemic strokes is independent of infarction site, the value was more between 51-70 years of age group and almost equal in both gender. 54 of the 60 ischemic strokes studied had CRP value >6 mg/l and only 6 patients had <6 mg/l (p<0.001), chi square test value is ²=73.65 which is statistically significant. Only 7 of the 60 control group had CRP >6 mg/l. Conclusion: In this study mean C-Reactive protein levels were significantly higher in patients with ischemic stroke when compared to controls. C-reactive protein level increases as age advances. C-reactive protein is a better prognostic marker with no gender predilection and not a mortality predictor.


2021 ◽  
Vol 9 (2) ◽  
pp. 184-197
Author(s):  
Diah Retno Wahyuningrum ◽  
Retnaningsih Retnaningsih ◽  
Martha Irene Kartasurya

Background: The occurrence of ischemia causes a loss of energy to switch to anaerobic processes resulting in acidosis due to reduced Adenosina Triphosphate (ATP). This condition makes neuron cells apoptotic. Apoptotic of several biochemical substrates in the brain, such as Glial Fibrillary Acidic Protein (GFAP) exit into the circulatory system which is associated with dysbiosis through immunological pathways.Objectives: To determine the effect of giving enteral formula containing protein, phosphatidylcholine, phosphatidylserine, and inulin on GFAP levels in patients with acute ischemic stroke Dr. Kariadi Hospital.Materials and Methods: This study was done in a single-blind RCT. Eighteen ischemic stroke patients were randomly divided into intervention (9 subjects) and control groups (9 subjects). The intervention group received 69 g of the powdered enteral formula three times a day for seven days. The formula contained protein (15 g), phosphatidylcholine (128 mg),  phosphatidylserine (32 mg), and inulin (3 g). The subject who had diabetes mellitus received for 14 days at a dose of 34.5 g per day (7.5 g protein with additions 64mg phosphatidylcholine, 16mg phosphatidylserine, 1.5 g inulin). The control group received the standard enteral formula from the hospital, which contains (11.8 g protein without additions protein, phosphatidylcholine, phosphatidylserine, and inulin). GFAP levels by ELISA method (Enzyme-linked immunosorbent Assay) at pre and post-intervention.Results: There was a trend of decreasing GFAP levels before and after in the intervention group towards a better direction from 8.37±4.25 to 8.30±4.9 compared with the control group which experienced an increasing trend from 5.4±1.8 to 7.5±4. There was no significant difference in GFAP levels after intervention between groups (p = 0.7).Conclusions: The addition of protein, phosphatidylcholine, phosphatidylserine, and inulin had no significant effect on GFAP levels.


2016 ◽  
Vol 94 (9) ◽  
pp. 657-662 ◽  
Author(s):  
Aleksey A. Kulesh ◽  
E. M. Kuklina ◽  
V. V. Shestakov

Introduction. Inflammation is probably the main process that links cardiovascular risk factors with damage to blood vessels and neurons. Elucidation of mechanisms of this relationship is an important issue. Materials and methods. 70 acute stroke patients were studied to assess their neuropsychological (MMSE, MoCA, FAB, Clock Drawing Test, Shulte Tables and Verbal Fluency) and functional status (mRS, RivermeadMobility Index). The serum and liquor IL-1β, IL-6, TNFa and IL-10 levels were analyzed. Control group included subjects without cerebrovascular diseases. Results. Stroke patients had higher IL-10 serum concentration than controls. No difference was found for other cytokines. There was correlation between serum and liquor cytokines levels. We found positive correlation between IL-1β, IL-6 and IL-10 levels. High IL-1β concentration was associated with vascular riskfactors, cardioembolic stroke, enhanced severity of cerebral stroke, low processing speed, impaired executive and visual-spatial functions and higher grade of mRS on discharge. The same pattern was revealed for IL-6 and IL-10. IL-6 level was related to mRS without relation to NIHSS on admission. High TNFa concentration was linked with vascular riskfactors, low MMSE score and processing speed. Discussion. Despite the antagonistic effects of IL-1β, IL-6 and IL-10 on inflammation, associations of these cytokines with anamnestic, clinical, neuropsychological and functional characteristics were similar in acute ischemic stroke. Probably, this fact indicates that during the acute ischemic brain damage process the immune response develops at the same time in pro- and anti-inflammatory directions. Its magnitude correlates with the damage severity and is associated with the effects of vascular riskfactors before stroke.


2020 ◽  
Author(s):  
Weiye Yang ◽  
Jian Yang ◽  
Xin Xiong ◽  
Xu Weng ◽  
Wenjing Wu

BACKGROUND Background: Stroke is one of the main causes of chronic disability and death, and infection is the most common complication of stroke and the main influencing factor of 30d mortality. Studies have shown that statins can reduce the incidence and mortality of cardiovascular and cerebrovascular events, as well as the expression of inflammatory factors. However, the effect of statins on the prognosis of patients with acute ischemic stroke complicated with infection has not been determined. OBJECTIVE Objective: To reduce the infection rate in patients with acute ischemic stroke, effect of statins on patients with acute ischemic stroke infection based on intelligent data acquisition of computed tomography image information was investigated. METHODS Methods: In this study, 122 infected patients with acute ischemic stroke in our hospital from June 2016 to December 2018 were included as subjects, and they were divided into test group (statin treatment, n=69) and control group (non-statin treatment, n=53). On admissionon, the differences in baseline data, stroke classification, neurological impairment, and the number of affected cerebral lobes between the two groups were compared; the probability of pulmonary, urinary system, and co-infection in patients with different stroke types was compared; the modified Rankin score and pap scale were used to evaluate the prognosis of patients; filter back projection (FBP) and iDose4 algorithms were used to reconstruct CT images of stroke patients, and the differences in noise and Signal to Noise Ratio (SNR) of reconstructed images by different algorithms were compared; CT images were used to qualitatively and quantitatively analyze the imaging characteristics of stroke patients and the affected cerebral lobes. RESULTS Results: The proportion of TACI in the control group was significantly higher than that in the test group (P<0.01); the incidence of pulmonary infection in patients with total anterior circulation infarct (TACI) typing in the control group was significantly higher than that in the test group (P<0.01); the Rankin and Barthel index scores of the test group at 0 months (3.30±0.34 vs 4.19±0.42; 45.71±8.26 vs 29.65±5.58), 1 months (3.17±0.36 vs 4.39±0.47; 47.79±7.79 vs 31.97±6.02), and 2 months (3.16±0.32 vs 4.14±0.40; 59.33±9.87 vs 35.80±6.21) were significantly higher than those of the control group (P<0.05); the noise in the image reconstructed by iDose4 method was significantly lower than that by FBP method (P<0.01); there were statistically significant differences between the control group and the test group in the proportion of involvement in the right parietal lobe, left insula, left internal capsule, subcortex, and right brain stem (P<0.05), CONCLUSIONS Conclusions: iDose algorithm can more effectively reconstruct CT images of stroke patients, and statins can significantly improve the left internal capsule and subcutaneous involvement of stroke patients, so as to effectively improve the prognosis of patients with acute stroke. CLINICALTRIAL Trial Registration: CRD42017079863


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D O Kang ◽  
C K Kim ◽  
Y Park ◽  
W Y Jang ◽  
W Kim ◽  
...  

Abstract Background Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB. Purpose We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke. Methods Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge. Result The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1±12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73–13.4; p=0.003; and HR 4.17; 95% CI: 1.74–10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757). One-year clinical outcomes Overall population (n=666) PSM population (n=328) no NB (=461) NB (n=205) Log-rank p-value OR (95% CI) no NB (n=164) NB (n=164) Log-rank p-value OR (95% CI) Recurrent ischemic stroke 6 (1.4) 14 (8.3) <0.001 5.73 (2.20–14.9) 3 (2.0) 11 (8.1) 0.026 3.85 (1.07–13.8) Transient ischemic attack 3 (0.7) 3 (1.7) 0.275 2 (1.3) 3 (2.1) 0.633 Hemorrhagic stroke 0 (0.0) 2 (1.2) 0.027 0 (0.0) 2 (1.5) 0.148 Total death 3 (0.7) 9 (4.8) 0.001 2 (1.3) 3 (1.9) 0.641 MACEs 12 (3.0) 25 (14.9) <0.001 4.63 (2.06–10.4) 7 (5.2) 17 (13.1) 0.030 2.95 (1.06–8.21) Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio. One-year clinical outcomes Conclusion SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.


Author(s):  
Vishali Kotwal ◽  
Rajesh Maini

Background: Stroke is a leading cause of death and disability worldwide acute ischaemic stroke accounts for 87% of strokes and mostly affects persons at the peak of their lives. Magnesium is known to have neuroprotective effects in ischemic stroke through a variety of mechanisms including decrease in glutamate release and inhibition of NMDA receptors and vasodilation. Previous studies on serum magnesium levels in stroke patients have shown variable results with many of them finding lower levels than in normal subjects. This study was undertaken to compare serum magnesium levels in patients of acute ischemic stroke with those of controls and also find a correlation if any between serum magnesium levels and neurological disability.Methods: This was a prospective non-interventional case-control study in which 50 patients of acute ischemic stroke in the age group of 20 to 80 years admitted in the department of Medicine Government Medical College Jammu from October 2019 to January 2020 were taken. Their serum magnesium levels were analysed within first 24 hours of admission and neurological disability was measured using modified Rankin Score. Serum magnesium levels were also estimated in 35 healthy controls for comparison.Results: Serum magnesium was lower in the study group (mean of 1.85±0.36) as compared to the control group (mean of 2.4±0.21) which was statistically significant (p value =0.001). Modified Rankin Score was 4 to 5 in 27 patients and 2 to 3 in 23 patients and it was negatively correlated with serum magnesium levels (r =-0.67).Conclusions: Ischemic stroke patients had lower serum magnesium levels as compared to healthy subjects in our study and also lower levels were seen in those with higher neurological disability.


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