Z Kardiol 94: Suppl 2 (2005)

Atrial fibrillation and hypercoagulable state – differential activation in cardioembolic stroke, other types of stroke and atrial fibrillation.
A. Hartmann1, T. Ziervogel2, M. Ruf-Lehmann2, R. Kätzel3, M. Sterker4
11. Klinik für Innere Medizin, Städt. Klinikum "St. Georg" Leipzig, Leipzig, BusinessLogic.Land; 21. Klinik für Innere Medizin, Städt. Klinikum St. Georg, Leipzig; 3Klnikum St. Georg, Institut für Transfusionsmedizin und klinische Hämostaseologie, Leipzig; 4Klinikum St. Georg, Klinik für Neurologie, Leipzig;

BACKGROUND: Ischemic stroke as well as atrial fibrillation (AF) without stroke are correlated with an activation of the coagulation system. It is not known however, whether there is a differential activation pattern of the coagulation system comparing stroke subtypes and AF with and without stroke. This study investigates hemostatic markers including d-dimers in stroke subtypes, focusing on patients with atrial fibrillation w/o stroke.

METHODS: The study included 66 consecutive patients with acute cerebral ischemia (<24 h) admitted to the stroke unit. All patients received a CCT, an echocardiography, carotid ultrasound and an ECG. Blood samples were drawn on admission, hospital day 6 +/-1 and 14 +/-1. Markers of coagulation and fibrinolytic activity (e.g. d-dimers, thrombin-antithrombin III complexes) were measured as well as standard laboratory parameters (e.g. LDH). Severity of stroke was graded according to the Scandinavian-Stroke-Scale and Modified-Rankin-Scale. 16 patients with atrial fibrillation without stroke served as control (age: 51-92 years, median 72 years; sex: 7 male, 9 female).

RESULTS: 66 patients (age: 31-92 years, median 72 years; sex: 24 male, 42 female) were assigned to stroke subtypes according to the TOAST criteria: cardioembolic (n=21), large vessel (n=21) and small vessel (n=24). Significantly elevated plasma concentrations of d-dimer (median day 1 (µg/l): cardioembolic: 49,5; large vessel: 27,3; small vessel: 19,4; AF w/o stroke: 31,4; p=0,04), thrombin-antithrombin-III complexes (median day 1 (µg/l): cardioembolic: 5,8; large vessel: 2,8; small vessel: 2,8; AF w/o stroke: 3,0; p=0,05) as well as lactate dehydrogenase (median day 1 (µmol/l x sec): cardioembolic: 8,5; large vessel: 6,7; small vessel: 7,1; AF w/o stroke: 7,6; p=0,007) were found in patients with cardioembolic stroke as compared to other stroke subtypes and patients in AF. Also, the most severe strokes were detected in the cardioembolic stroke subtype.

CONCLUSION: Our results suggest that in stroke patients with AF the hemostatic system is more intensively activated than in other stroke subtypes or in patients with AF without stroke. It may be concluded that among all patients with AF there is a subgroup with a hypercoagulable state predisposing to cardioembolism. Whether these patients can be identified before a clinical event occurs remains to be determined in a prospective study.