Routine coagulation testing in acute stroke

Abstract

Uvod: Promjene u sustavu hemostaze mogu pridonijeti razvoju tromboembolijskih i hemoragijskih bolesti. Stoga je glavni cilj ovoga rada bio istražiti povezanost koagulacijskih pretraga koje se uobičajeno određuju po prijemu bolesnika s akutnim moždanim udarom (MU), njihov odnos s (pod)tipovima MU-a i ishodom nakon akutnoga MU-a. Materijali i metode: Retrospektivno su pregledani podatci o 262 pacijenta hospitaliziranih u razdoblju od siječnja do lipnja 2011. godine na Klinici za neurologiju Zavoda za cerebrovaskularne bolesti Kliničke bolnice „Sveti Duh” suspektnih na akutni moždani udar. Klasifikacija MU-a temeljena je na kliničkoj slici i nalazima neuroradiološke obrade, dok se ishod MU-a procjenjivao pomoću modificirane Rankinove ljestvice. Analizirani su rezultati koagulacijskih pretraga: PV-INR APTV, fibrinogena i D-dimera prilikom prijema pacijenata u bolnicu. Za sve pacijente izračunat je i omjer D-dimera i fibrinogena. Rezultati: U konačnu analizu uključena su 74 pacijenta, 67 s ishemijskim MU-om, od čega je u 22 pacijenta MU klasificiran kao lakunarni, a u 10 pacijenata kao hemoragijski. Nađena je umjerena, ali značajna pozitivna korelacija između vrijednosti D-dimera i modificirane Rankinove ljestvice (r = 0,470, CI% = 0,271-0,631; P < 0,0001). Tijekom hospitalizacije preminulo je 16 % bolesnika. Vrijednosti D dimera po primitku u bolnicu bile su statistički značajno više u bolesnika koji nisu preživjeli u odnosu na bolesnike koji su preživjeli MU (604 naspram 224 μg/L, P < 0,0001) kao i u bolesnika s dijagnosticiranim ishemijskim MU-om klasificiranim kao nelakunarni u odnosu na bolesnike s klasificiranim lakunarnim MU-om (294 naspram 206 μg /L. P = 0,02). Vrijednosti drugih koagulacijskih pretraga i omjera D-dimera i fibrinogena nisu se značajno razlikovale među ispitivanim grupama. Zaključak: Istraživanje je pokazalo da su povišene vrijednosti D-dimera povezane s lošijim ishodom nakon akutnoga MU-a te da njihovo određivanje po primitku može biti indikativno u smislu prognoze i ishodaIntroduction: Changes in haemostatic system could contribute to the development of thromboembolic and haemorrhagic disease. The main objective of this study was to explore the relationship between coagulation tests commonly used in the clinical settings on patient’s admission, stroke types and patient’s outcome. Patients and methods: Patients’ hospital charts and documentation were retrospectively reviewed for 262 patients admitted to the Stroke and Intensive Care Unit, Department of Neurology at “Sveti Duh” University Hospital, Zagreb, Croatia from January to June 2011 under the suspected diagnosis of acute stroke. Classification of stroke types was primarily based on clinical picture and imaging studies, whereas degree of patients’ disability and outcome was measured by modified Rankin Scale (mRS). Results of the coagulation test PT-INR, APTT, fibrinogen and D-dimer performed on admission were recorded. For all patients the D-dimer to fibrinogen ratio was also calculated. Results: Total of 74 patients were enrolled in the study, 67 with ischemic stroke whereby 22 of them were classified as patients with lacunar stroke and 10 as patients with haemorrhagic stroke. During hospitalisation 16% of patients did not survive. The median D-dimer value on admission was significantly higher in non-survivors than in survivors (604 vs. 224μg/L, P < 0.0001), as well as in patients with ischemic non-lacunar stroke in comparison to lacunar stroke (294 vs. 206 μg /L. P = 0.02). Although moderate, significant correlation was observed between elevated DD levels and mRS scale (r = 0.470, CI% = 0.271-0.631; P < 0.0001). Other coagulation parameters, as well as D-dimer/fibrinogen ratio, considered in the study did not show any significant difference between stroke type or survival. Conclusions: Our study revealed that increased DD levels in acute phase of the stroke are associated with stroke outcome and that their determination on admission could be indicative of prognosis and outcome