Activation of coagulation in acute cardioembolic stroke.

Takano, Kentaro; Yamaguchi, Takenori; Kato, Harubumi; Omae, T

doi:10.1161/01.str.22.1.12

Cited by 77 publications

(67 citation statements)

References 23 publications

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“…However, none of the patients in this study fulfilled the diagnostic criteria for DIC as defined by the Japanese Ministry of Health and Welfare, and none of them had any non-cerebral vascular lesions ( 16). Blood coagulation system is activated most prominently in cardioembolic stroke, and subsequently in atherothrombotic cerebral infarction (17)(18)(19). However, in lacunar cerebral infarction, these hemostatic markers are not prominently altered (20)(21)(22).…”

Section: Discussionmentioning

confidence: 78%

Effects of an Antithrombin Drug in Patients with Subacute Exacerbations of Binswanger Disease.

et al. 2000

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The blood coagulation system has been shown to be activated in subacute exacerbations of Binswanger disease (BD). In our previous study, the antithrombin drug argatroban ameliorated the neurological exacerbations in a BDpatient with antiphospholipid antibody syndrome. We have further examined the therapeutic efficacy of argatroban in 3 BDpatients with subacute exacerbations, but without any immune-mediated prothrombotic complications. In 1 out of these 4 patients, treatment with sodium ozagrel, an antiplatelet drug was applied, but was ineffective. In all patients, argatroban treatment reduced the levels of the hemostatic markers, with a corresponding improvement in cognitive dysfunction and gait disorders. These results suggest that the antithrombin effect is true also for BDpatients not compromised by the immune-mediated prothrombotic condition. (Internal Medicine 39: 966-969, 2000)

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Section: Discussionmentioning

confidence: 78%

Effects of an Antithrombin Drug in Patients with Subacute Exacerbations of Binswanger Disease.

et al. 2000

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“…Top, patient with CBE;Bottom, control subject; Right, maximumLAAarea; Left, minimumLAAarea (transverse plane by transesophageal echocardiograms). It has been clearly shown that left atrial dysfunction due to atrial stunning can be recovered for dozens of minutes after the cessation of PAF, whereas, prolongation of the atrial stunning has been suggested to play a critical role in the thrombus formation in LAA by experimental studies (39)(40)(41)(42) Previous clinical reports demonstrate that the nature of altered coagulation and fibrinolysis are different in various subtypes of ischemic stroke (45). Especially, plasma levels of D-dimer and thrombin-antithrombin III complex are significantly higher in cases with cardioembolic stroke, compared with atherothrombotic or lacunar stroke (46).…”

Section: Resultsmentioning

confidence: 99%

“…Especially, plasma levels of D-dimer and thrombin-antithrombin III complex are significantly higher in cases with cardioembolic stroke, compared with atherothrombotic or lacunar stroke (46). Therefore, screening of the prethrombotic state using these hemostatic markers is useful for the assessment and identification of stroke subtype (45,46). On the other hand, it has been reported that there are no significant differences in fibrinocoagulation activity (including D-dimer) between patients with PAF (including paroxysmal periods) and normal sinus controls (47,48).…”

Section: Resultsmentioning

confidence: 99%

Direct Evidence that Sustained Dysfunction of Left Atrial Appendage Contributes to the Occurrence of Cardiogenic Brain Embolism in Patients with Paroxysmal Atrial Fibrillation

et al. 2003

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Objective The goal of this study was to investigate transesophageal echocardiographic (TEE) findings after the termination of atrial fibrillation to clarify the direct evidence for occurrence of acute cardiogenic brain embolism (CBE) in patients with paroxysmal atrial fibrillation (PAF).Patients and Methods Among98 consecutive patients with CBE, we investigated TEE in 16 patients with PAF (Group CBE, 72±10 years) within 7 days of the onset and 2 weeks after the first study, in comparison with 15 agematched PAF patients without CBE(Group N). The duration from reversal to normal sinus rhythm to first TEE was 6±1 days in both groups. Results There were no significant differences in left atrial dimension and emptying flow velocity of the left atrial appendage (LAA-eV) between groups. Group CBE had significantly larger LAA area (4.3±1.3 cm2 vs. 3.1±1.0 cm2, p<0.05), smaller LAAfractional area change (LAA-FAC) (43±25% vs. 80±22%, p<0.001), and a higher incidence of left atrial spontaneous echo contrast (LAA-SEC) (25% vs. 7%, p<0.05) than group N, and those abnormalities in group CBEwere significantly improved at the second TEE (LAA area: to 3.2±0.9 cm2, p<0.05; LAA-FAC: to 84±26%, p<0.001; LAA-SEC: to 0%, p<0.05),respectively. Conclusion LAA-FAC is a more sensitive marker for LAAdysfunction than the widely used index, LAA-eV, and a sustained deterioration of LAA-FACmay be direct evidence for thrombus formation and occurrence of acute CBE in patients with PAF.

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“…27 Thus, plasma concentrations of TAT and D-dimer are useful indicators of patients who are prone to recurrent embolization. 28,29 In the present study, to prove a direct relationship between serum FM level and LAA thrombus occurrence, we performed a multivariate logistic regression analysis of data from more than 200 patients with cerebral infarction, which clearly showed that serum FM level was an independent predictor for LAA thrombus, as compared with TAT, PAI-1, PIC, Ddimer, FDP, and the NIHSS score, which reflect the severity of cerebral infarction.…”

Section: Discussionmentioning

confidence: 79%

Higher Levels of Serum Fibrin-Monomer Reflect Hypercoagulable State and Thrombus Formation in the Left Atrial Appendage in Patients With Acute Ischemic Stroke

Okuyama

Hirono

Liu

et al. 2006

Circ J

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Stroke has characterized cardioembolic stroke as an important clinical entity, because it is the most common cause of death in cases of acute ischemic stroke. [1][2][3] Transesophageal echocardiography (TEE) is accepted as a crucial investigation for detecting the thromboembolic source and determining stroke subtype. However, it is sometimes difficult to make a diagnosis because of the splashing and vanishing of the intracardiac source of the emboli. [4][5][6][7][8][9][10][11][12] In patients with cardioembolic stroke it is necessary to carefully examine the intracardiac hypercoagulable state based on echocardiographic findings and/or serum sensitive markers, and then use this information to prevent recurrent attacks.It is well known that the left atrial appendage (LAA) is a major thromboembolic source in cardioembolic stroke. 7,8 Many clinical reports have shown a close relationship between LAA thrombus formation and left atrial mechanical remodeling, based on echocardiographic findings such as the presence of spontaneous echo contrast or a progressive Circulation Journal Vol.70, August 2006 reduction in LAA emptying flow velocity. 6,10,12,13 Serum fibrin monomer (FM) is a precursor of the fibrin polymer that is produced by the thrombin-mediated resolution of fibrinopeptide A from fibrinogen. In vivo, compared with fibrin polymer and stable fibrin, FM is fragile as a result of fibrinolysis. Therefore, it is thought to be a sensitive marker of a hypercoagulable state. 14,15 It has been reported that the measurement of serum FM level is a useful screening tool for identifying older individuals at increased risk of ischemic stroke. 16,17 The goal of this study was to investigate the association of serum FM level with LAA flow pattern alteration and thrombus formation in order to establish whether the serum level of FM is a sensitive screening tool for diagnosing stroke subtypes in the acute stroke care unit. Methods Study PatientsAmong 237 consecutive patients with acute cerebral infarction, 204 satisfied all of the following criteria: (1) abrupt stroke onset while awake with a maximal neurological deficit, (2) admission within 24 h of symptom recognition, (3) underwent measurement of serum coagulation and fibrinolytic activity on admission, (4) underwent TEE within 7 days of onset, (5) did not received oral administration of warfarin and/or treatment by intravenous infusion of thrombolytic agents or heparin, and (6) Background It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke. Methods and ResultsTwo hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum l...

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Activation of coagulation in acute cardioembolic stroke.

Cited by 77 publications

References 23 publications

Effects of an Antithrombin Drug in Patients with Subacute Exacerbations of Binswanger Disease.

Effects of an Antithrombin Drug in Patients with Subacute Exacerbations of Binswanger Disease.

Direct Evidence that Sustained Dysfunction of Left Atrial Appendage Contributes to the Occurrence of Cardiogenic Brain Embolism in Patients with Paroxysmal Atrial Fibrillation

Higher Levels of Serum Fibrin-Monomer Reflect Hypercoagulable State and Thrombus Formation in the Left Atrial Appendage in Patients With Acute Ischemic Stroke

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