ABSTRACT
Considerable evidences suggest an important role for hypercoagulability as a contributor to stroke outcome. The levels of many hemostatic markers change at the onset of stroke, howevere, it is still unsetteled whether those abnormalities pre-existant O. secondary to the acute event. This prospective study was undertaken in order to evaluate the prognostic significance of the hemostatic markers; beta-thromboglobulin [beta TG], fibrinopeptide-A [FPA] and protein-C [PC] activity.40 consecutive ischemic stroke patients were included during the first 48 hours of the onset. Stroke clinical examination scale [SCES] and CT brain scan were assessed. In order to assay the hemostatic markers, blood samples were drawn within 48 hours, after one week and after six weeks of the stroke onset. Plasma were prepared and tested for platelet activation, signed by beta TG and coagulation activation signed by FPA and PC activity. For comparison, 20 patients with nonvascular diseases were tested for these markers. Within 48 hours of the stroke onset significant elevation of betaTG and FPA associated with significant decrease of PC activity was observed in stroke patients compared to the controls. Observable reduction of betaTG and FP A with gradual elevation of PC activity occurred after one week. Further reduction of betaTG and FPA, and increase of PC activity occurred after six weeks of the stroke onset. Moreover, marked activation of the platelet and coagulation system was observed among patients who had severe stroke, extensive infarction as well as those who died during the study in comparison to patients with less severe stroke, small sized infarction and the survivors respectively. In conclusion, marked activation of platelet and coagulation occurs in the acute phase of ischemic stroke with subsequent decreament. The initial changes are more obvious in the patients with extensive infarction and poor prognosis. This may rise the importance of the hemostatic markers; betaTG, FPA and PC activity as prognostic factors rather than factors contributing only, to the thrombotic event