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Primary hemostasis, coagulation and fibrinolysis markers in patients with intracranial large vessel occlusion stroke, on admission to hospital

1Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands, Papendrecht, Zuid-Holland, Netherlands, 2Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands, Amsterdam, Noord-Holland, Netherlands, 3Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands, Rotterdam, Zuid-Holland, Netherlands, 4Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, and Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands, Rotterdam, Zuid-Holland, Netherlands, 5Erasmus University Medical Center, Rotterdam, The Netherlands, Rotterdam, Zuid-Holland, Netherlands

Abstract Number: PB0025

Meeting: ISTH 2022 Congress

Theme: Arterial Thromboembolism » Cerebrovascular Disorders

Background: Acute Ischemic Stroke (AIS) is most often caused by thromboembolic occlusion of the cerebral blood vessels. Changes in the primary hemostasis, coagulation, and fibrinolysis systems are important causal factors in thrombus formation but information on the levels at the acute moment of stroke are limited. Better understanding of hemostatic and fibrinolytic factors will help us to predict the risk of developing AIS and effects of treatments.

Aims: To study the levels and activities of primary hemostasis, coagulation, and fibrinolysis markers in patients with AIS.

Methods: We used data from patients with AIS of included in MR CLEAN-NOIV trial. We measured hemostatic factors von Willebrand Factor Antigen (VWF:Ag), ADAMTS13, FVIII, fibrinogen, D-dimer, and tissue-Plasminogen Activator (tPA) in citrated plasma of AIS patients collected on admission to hospital. Hemostatic factors levels and activity were presented as either mean and standard deviation (SD) or median and inter-quartile range (IQR) in case of skewedness.

Results: We included 131 AIS patients. ADAMTS13 activity (mean 65 ± SD 23%, (Ref. 41-129%)) was normal in AIS patients, whereas the levels of VWF:Ag (mean 2.26 ± SD 1.10 U/mL, (Ref. 0.60-1.40 U/mL)), FBG (mean 2.58 ± SD 1.44 g/l (Ref. 1.5-3.6 g/l)), D-dimer (median 1.07 mg/L [IQR 1.47], (Ref. < 0.50 mg/L)), FVIII (median 1.47 U/mL [IQR 1.41], (Ref. 0.60-1.40 U/mL)), and tPA:Ag (median 10.69 ng/ml [IQR 10.97], (Ref. < 10 ng/mL)) were extremely increased in these patients compared to references (Ref). tPA:Ag in 49 patients was extremely high (>511 ng/ml).

Conclusion(s): In patients with AIS, we found increased levels of VWF:Ag, FBG, FVIII, D-dimer and tPA:Ag on admission to hospital. These findings indicate that the primary hemostasis, coagulation, and fibrinolysis systems are disturbed in AIS patients. Increased levels of hemostatic and fibrinolytic markers might be involved in pathogenesis of AIS and clinical failure of AIS thrombolysis treatment.

To cite this abstract in AMA style:

Barakzie A, Bruggeman A, Dirks G, Dippel D, Charles M, de Maat M. Primary hemostasis, coagulation and fibrinolysis markers in patients with intracranial large vessel occlusion stroke, on admission to hospital [abstract]. https://abstracts.isth.org/abstract/primary-hemostasis-coagulation-and-fibrinolysis-markers-in-patients-with-intracranial-large-vessel-occlusion-stroke-on-admission-to-hospital/. Accessed September 21, 2023.

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