We evaluated 106 subjects with and 109 subjects without a history of ischemic stroke. All were attending a metabolic ward. The two groups were compared for major risk factors for ischemic events. A positive family history for ischemic complications of atherosclerosis was more common in subjects with a history of stroke than in those without; moreover, plasma levels of plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (TPA) were higher in patients with documented previous events. A strong positive significant correlation was found between TPA and PAI-1 levels, and an interaction between age and TPA was observed when the sample was stratified according to ages S troke is a major thrombotic complication of atherosclerosis and a leading cause of morbidity and mortality in Western countries. Individuals who smoke, who have high plasma levels of cholesterol or glucose or high blood pressure, or who are obese are all at risk for this event.15 However, such established risk factors account for only about one third of the future ischemic episodes. 68 The involvement of hemostasis in arterial thrombosis has been suspected for many years, but only recently has it been supported by clinical observations and intervention studies.910 Crosssectional and prospective studies 1115 have documented that the impaired fibrinolysis of patients with angina pectoris or previous myocardial infarction is related to elevated plasma levels of the principal inhibitor of the fibrinorytic system, plasminogen activator inhibitor-1 (PAI-1). High levels of PAI-1 have also been reported in myocardial reinfarction, 16 in the juvenile myocardial ischemia of patients with diabetes mellirus and/or hypertrigh/ceridemia, 17 in hyperinsulinemia, 18 and in anReceived April 6, 1994; revision accepted August 31, 1994. From the Qinica Medica, Istituto di Medicina Interna e Malattie Dismetaboliche, Universita di Napoli, and Unita di Trombosi e Aterosclerosi, I.R.C.C.S. "Casa Sollievo della Sofferenza," S. Giovanni Rotondo, Italy.Presented in part at the XIV Congress of the International Society on Thrombosis and Haemostasis, New York, NY, July 4-9, 1993, and published in abstract form (Thromb Haemost. 1993;69:820).Reprint requests to Giovanni Di Minno, MD, Clinica Medica, Istituto di Medicina, Interna e Malattie Dismetaboliche, Via S. Pansini, 5, 80131, Napoli, Italy.O 1994 American Heart Association, Inc.being above or below 70 years. When the patient population was analyzed according to the number of ischemic events, it was found that 62 of the 106 subjects with a history of stroke had experienced more than one ischemic event. Under these conditions, the levels of TPA and PAI-1 still correlated with the occurrence of previous ischemic episodes. As in the whole patient sample, TPA was the strongest discriminator. We conclude that in subjects attending a metabolic ward, TPA and PAI-1 levels consistently help identify subjects with a history of cerebral ischemic episodes and that TPA is the strongest discriminator. (Ar...