Hemostatic markers in acute transient ischemic attacks.

Fon, Edward A.; Mackey, Ariane; Côté, Robert; Wolfson, Christina; McIlraith, D M; Leclerc, Jacques; Bourque, François

doi:10.1161/01.str.25.2.282

Cited by 46 publications

(34 citation statements)

References 34 publications

(17 reference statements)

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“…We chose to evaluate these biomarkers because acute ischemic stroke has been associated with serum elevations of a series of immuno-inflammatory variables such as TNF-␣, interleukin-6 (IL-6) and other cytokines, selectins and adhesion molecules [7][8][9][10] and of markers of impaired hemostasis and thrombosis [11][12][13].…”

Section: Methodsmentioning

confidence: 99%

Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis

et al. 2009

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a b s t r a c tIntroduction: Accumulating evidence suggests that inflammation plays an important role in the development of acute cerebrovascular disease. The aim of this study is to evaluate the predictive value of a series of candidate serum immuno-inflammatory and thrombotic/fibrinolitic molecules towards diagnosis of acute ischemic stroke. Materials and methods:We enrolled 120 consecutive patients with a diagnosis of acute ischemic stroke and 123 consecutive hospitalized control patients without a diagnosis of acute ischemic stroke. We evaluated plasma levels of IL-1␤, TNF-␤, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1 and sVCAM-1 as markers of immuno-inflammatory activation, vWF plasma levels as a marker of endothelial dysfunction, TPA antigen and PAI-1 plasma levels as a marker of a prothrombotic state. Results: TNF-␣, PAI-1 and TPA on bivariate logistic regression were highly correlated to stroke diagnosis. Among the other variables maintained in the final model IL␤, Selectin E, were significantly associated with acute ischemic stroke diagnosis, whereas IL-6, VICAM-1, ICAM-1 and neutrophil percentage showed only a slight or no association with stroke diagnosis. Furthermore, only the continuous values of TNF-␣, PAI-1 and TPA showed a significant predictive value and likelihood ratio, with an area under the ROC curve of 98.6%, 97.1% and 99.9%, respectively. Discussion: Our findings could suggest the high diagnostic power of these immuno-inflammatory and thrombotic/fibrinolytic variables in patients with acute ischemic stroke. Although our results are encouraging, additional studies are needed to establish the validity of this approach.

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Section: Methodsmentioning

confidence: 99%

Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis

et al. 2009

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“…D-dimer appears to be more sensitive than other hemostatic markers, such as fibrinopeptide A and B-thromboglobulin, particularly for cardioembotic stroke (16,17 ).…”

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confidence: 92%

Identification of Novel Brain Biomarkers

Modur²,

et al. 2006

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Background:The diagnosis of diseases leading to brain injury, such as stroke, Alzheimer disease, and Parkinson disease, can often be problematic. In this study, we pursued the discovery of biomarkers that might be specific and sensitive to brain injury. Methods: We performed gene array analyses on a mouse model to look for biomarkers that are both preferentially and abundantly produced in the brain. Via bioinformatics databases, we identified the human homologs of genes that appeared abundant in brain but not in other tissues. We then confirmed protein production of the genes via Western blot of various tissue homogenates and assayed for one of the markers, visinin-like protein 1 (VLP-1), in plasma from patients after ischemic stroke. Results: Twenty-nine genes that were preferentially and abundantly expressed in the mouse brain were identified; of these 29 genes, 26 had human homologs. We focused on 17 of these genes and their protein products on the basis of their molecular characteristics, novelty, and/or availability of antibodies. Western blot showed strong signals in brain homogenates for 13 of these proteins. Tissue specificity was tested by Western blot on a human tissue array, and a sensitive and quantitative sandwich immunoassay was developed for the most abundant gene product observed in our search, VLP-1. VLP-1 was detected in plasma of patients after stroke and in cerebrospinal fluid of a rat model of stroke. Conclusions: The use of relative mRNA production appears to be a valid method of identifying possible biomarkers of tissue injury. The tissue specificity suggested by gene expression was confirmed by Western

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“…In many respects, the ischemic cascade of glial activation and ischemic neuronal injury is far more complex than myocardial ischemia and less amenable to the use of a single biochemical marker. For example, acute stroke has been associated with serum elevations of numerous inflammatory and antiinflammatory mediators such as interleukin 6 (IL-6) and matrix metalloproteinase-9 (MMP-9), 4 -9 markers of impaired hemostasis and thrombosis, 10,11 and markers of glial activation such as S100␤. 12,13 Several of these mediators, including IL-6, are elevated within hours after ischemia and correlate with infarct volume.…”

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confidence: 99%

Novel Diagnostic Test for Acute Stroke

Lynch

Blessing

White

et al. 2004

Stroke

213

124

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Background and Purpose-The absence of a widely available and sensitive diagnostic test for acute cerebral ischemia remains a significant limitation in the diagnosis and management of stroke. The objective of this study was to examine the feasibility of developing a diagnostic panel of blood-borne biochemical markers of cerebral ischemia. Methods-Serial blood samples were obtained from patients (nϭ65 with suspected ischemic stroke, nϭ157 control subjects) presenting to an academic medical center emergency department. We analyzed 26 blood-borne markers believed to play a role in the ischemic cascade and created a 3-variable logistic regression model to predict the clinical diagnosis of stroke, defined as persistent neurological symptoms of cerebral ischemia lasting Ͼ24 hours. Results-Of the 26 blood-borne markers analyzed, univariate logistic analysis revealed that 4 were highly correlated with stroke (PϽ0.001): a marker of glial activation (S100␤), 2 markers of inflammation (matrix metalloproteinase-9 and vascular cell adhesion molecule), and 1 marker of thrombosis (von Willebrand factor). When the outcome level was set to a cutoff of Pϭ0.1, our logistic model provided a sensitivity and specificity of 90% for predicting stroke. Conclusions-A panel of blood-borne biochemical markers may be helpful in identifying patients with acute cerebral ischemia who could benefit from urgent care. Such a test may also be helpful in identifying stroke patients in the prehospital setting so that they could be fast-tracked to an institution equipped to care for patients with acute stroke.

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Hemostatic markers in acute transient ischemic attacks.

Cited by 46 publications

References 34 publications

Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis

Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis

Identification of Novel Brain Biomarkers

Novel Diagnostic Test for Acute Stroke

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