Fibrogênio como fator de risco independente de doença vascular cerebral / Fibrinogen as independent risk factor for ischemic stroke

No protocolo de avaliaçäo clínico-laboratorial de pacientes com acidente vascular cerebral (AVC) aterotrombótico dosamos e analisamos níveis de fibrinogênio plasmático (técnica de Clauss automatizada), para determinar seu possível papel como fator de risco trombogênico em 29 pacientes (20 homens e 9 mulheres) com idades entre 25 a 79 anos (mediana=55); todos tinham tido AVC aterotrombótico. Eles foram classificados em 2 grupos segundo alteraçöes de fluxo nas carótidas: g1 - sem alteraçäo de fluxo (n=19) e g2 - com alteraçöes de fluxo (n=10). Resultados- A média das dosagens de fibrinogênio no g1 foi de 269 e no g2 de 353 mg/dl. Quarenta e sete por cento dos pacientes do g1 e 80 por cento do g2, apresentaram medidas >300 mg/dl. As diferenças obtidas entre os grupos neste estudo foram significante. Conclusäo- Considerando o nível de risco epidemiológico de 300 mg/dl, nossos resultados sugerem que o fibrinogênio é um fator de risco independente para AVC aterotrombótico, especialmente naqueles com alteraçäo de fluxo carotídeo.

Platelet functions & lipid profile within 24 hours following an attack of TIA, thrombotic & haemorrhagic stroke.

The present study was undertaken to evaluate comparatively the lipid profile and platelet functions within 24 h of the three most frequent types of stroke encountered in clinical practice. Twenty patients of transient ischaemic attacks, 22 of thrombotic stroke and 26 of haemorrhagic stroke (hypertensive putaminal haemorrhage), all within 24 h of the acute event, and 21 control subjects were studied. Spontaneous platelet aggregation, platelet aggregation induced with adenosine diphosphate (2.5, 3.75 and 5.0 microM) and lipid profile (serum cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein) estimations were performed in all the subjects. Mean platelet aggregation values were significantly lower in haemorrhagic stroke patients as compared to controls. Serum cholesterol, triglycerides and very low density lipoprotein levels in ischaemic groups i.e., transient ischaemic attacks and thrombotic stroke patients, were significantly elevated, more so in the former group. It appears that platelet hypofunction has a role in the pathogenesis of hypertensive putaminal haemorrhage while in patients of transient ischaemic attack and thrombotic stroke, lipids may be a contributing factor in cerebral atherogenesis.

Platelet functions and lipid profile in haemorrhagic and thrombotic stroke patients.

The present study was conducted in 17 patients of haemorrhagic stroke (HS), 19 patients of thrombotic stroke (TS) and 14 control subjects. In each subject platelet functions (spontaneous platelet aggregation (SPA), aggregation induced with 10, 5, 2.5 microM ADP and 10 micrograms/ml of collagen) and complete lipid profile (total cholesterol, triglycerides, high density lipoprotein [HDL], low density lipoprotein [LDL], very low density lipoprotein [VLDL] and LDL/HDL ratio) were performed within 7 days of onset of stroke. Platelet aggregation with 2.5 microM ADP was significantly lower (P < 0.05), in both the stroke groups in comparison to controls. No other changes were significant. Mean serum triglycerides and VLDL of TS group were significantly higher than that of controls. Mean LDL/HDL ratio of the same group was significantly lower than HS group. It can be concluded that alterations in platelet functions and lipid profile are induced by both types of strokes in acute stage.

Platelet norepinephrine efflux in thrombotic stroke.

Twenty CT proven patients of thrombotic stroke who were non-diabetic, non-hypertensive and non-hyperlipidemic were evaluated in acute phase (within 7 days of onset of neurological deficit) for platelet count and spontaneous platelet norepinephrine (NE) efflux, measured as the fraction (of initial total content) of 3H-NE released from platelets in 30 and 60 min. NE efflux was significantly greater (P less than 0.001) in stroke patients (34.09 +/- 4.92% at 30 min and 50.45 +/- 7.1% at 60 min) as compared to controls (23.27 +/- 4.16% at 30 min and 39.49 +/- 3.27% at 60 min). This excessive efflux may result in increased concentrations of NE in local plasma, which by causing enhanced platelet aggregation and damage to vascular endothelium and vasospasm, may contribute towards the development and progression of cerebral thrombosis.

Hematocrit in thrombotic stroke at Ramathibodi Hospital.

A hospital-based study of the relationship between the hematocrit and thrombotic stroke was carried out among 117 patients admitted to Ramathibodi hospital. There was no significant difference in the age of patients with and without CT scan. Six patients, three males and one female with CT scan and one male and one female who did not have CT scan were found to have polycythemia vera. Ten patients had relative polycythemia (five had CT scan and five without CT scan). The mean age of patients with PV and relative polycythemia was not significantly different from those without polycythemia. The mean Hct in those with PV and relative polycythemia was generally higher than those without polycythemia. We recommended that Hct should be determined in every thrombotic stroke and a high Hct should be further studied for evidence of polycythemia vera or relative polycythemia.

Estudio de lípidos en pacientes con trombosis cerebral / Study of lipids in patients with cerebral thrombosis

Se estudian las cifras de colesteroles, triglicéridos y lipoproteínas en un grupo de 87 pacientes con trombosis cerebral (TC), en las primeras 24 a 48 horas del accidente. Se delinearon 4 subgrupos según sus antecedentes patológicos personales (APP): 28 hipertensos, 12 diabéticos, 23 diabéticos e hipertensos y 24 pacientes sin esos antecedentes. Los valores obtenidos en el grupo total y en cada uno de los subgrupos se compararon entre sí y con un grupo control. Se analizaron estas variables en relación con la evolución. Los resultados se muestran en tablas y gráficos. En general, independientemente de la edad, sexo y APP, las cifras de triglicéridos fueron más bajas en los enfermos (72 ñ 49 mg/dL), sobre todo en los pacientes de peor evolución (61 ñ 38 mg/dL) en comparación con el grupo control (102 ñ 53 mg/dL), resultado muy significativo desde el punto de vista estadístico; esto puede tener implicaciones en el pronóstico