Serial changes in markers measuring coagulation, fibrinolysis and vasoactivity in patients with ischemic stroke
نویسندگان
چکیده
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Review of the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Ischemic stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Risk factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Pathophysiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Classifi cation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Clinical aspects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Pharmacotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Stroke unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Future of stroke care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Prevention of stroke recurrence. . . . . . . . . . . . . . . . . . . . . . . . 18 Antithrombotic treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Invasive treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Outcome following . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Hemostasis and thrombogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Endothelial functions and endothelin-1 . . . . . . . . . . . . . . . . . . . . . . . 21 Homocysteine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Platelets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Coagulation system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Regulation of coagulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Tissue factor pathway inhibitor (TFPI) . . . . . . . . . . . . . . . . 30 Antithrombin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Protein C pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Factor V Leiden mutation (FVLm) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fibrinolysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Aims of the study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Subjects and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Subject characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Brain imaging and infarction classifi cation. . . . . . . . . . . . . . . . . . . . . . . . . . 38 Assessment of neurological status and outcome. . . . . . . . . . . . . . . . . . . . . 38 Blood sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Statistical methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 General information about IS patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Markers measuring coagulation, fi brinolysis, and vasoactivity in patient subgroups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 ET-1 (Study I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Hcy (Study II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Markers measuring activity of coagulation and fi brinolysis (F1+2, TAT, t-PA:Ag, PAI-1, and D-dimer, Study III) . . 46 Natural anticoagulants (AT, PC, and PS, Study IV) . . . . . . . . . . . . 48 FVLm (Study V) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Markers measuring coagulation, fi brinolysis, and vasoactivity and stroke etiology, severity, outcome, and recurrence (Studies I–V) . . . . . . . 50 Brain imaging (Studies II, V). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Changes in markers measuring coagulation, fi brinolysis, and vasoactivity over time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 ET-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Hcy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Fibrinolysis and coagulation markers (F1+2, TAT, t-PA:Ag, PAI1, D-dimer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Natural anticoagulants (AT, PC, and PS) . . . . . . . . . . . . . . . . . . . . . . 56 Markers measuring coagulation, fi brinolysis, and vasoactivity and stroke risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Markers measuring coagulation, fi brinolysis and vasoactivity, and stroke etiology, severity, outcome, and recurrence rate . . . . . . . . 58 Infl uence of markers measuring coagulation, fi brinolysis, and vasoactivity on radiological fi ndings . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Summary and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Original publications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
منابع مشابه
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