Biochemical markers of thrombotic complications in the acute period of ischemic stroke; [Биохимические маркеры тромботических осложнений в остром периоде ишемического инсульта]

Aim. To study the profile of biochemical markers of the hemostasis system, to clarify their role and relationships in the pathogenesis of the development of thrombotic complications (TC) of ischemic stroke (IS) and the associated assessment of the possibilities of their diagnostic application. Materials and methods. The study group included 302 patients (164 men, 138 women) who were admitted to the hospital with a diagnosis of IS within 24 hours of the onset of the disease. The diagnosis was confirmed by computed tomography. The average age of patients was 69 (50–88) years. Blood was taken from all patients on the 1st day of the disease to determine the profile of analytes presumably associated with the pathogenesis of TC. Levels of homocysteine, protein C inhibitor, thrombomodulin, plasminogen, tissue plasminogen activator, urokinase, plasminogen activator type 1 inhibitor, t-PA/PAI-1 complex, vitronectin, plasmin-α2-antiplasmin complex, D-dimer, fibronectin were determined in blood serum by ELISA. Results. TC in the acute period of IS (up to 21 days) were recorded in 32 (10.6%, 95% CI 7.37–14.3) patients, of which pulmonary embolism was observed in 27 (8.94%, 95% CI 5.98–12.4) patients, deep vein thrombosis in 5 (1.66%, 95% CI 0.47–3.47) patients. The results of the study of a panel of specific proteins involved in pathogenetic processes accompanying necrosis of brain tissue in IS demonstrated that of the entire list of markers of the hemostasis system activation selected for the study, the most significant are: the concentration of fibronectin in the prognosis of the absence of TC with a threshold value of more than 61 mkg/ml and OR 4.4 (95% CI 1.5–12.9, p=0.011), and the concentration of the t-PA/PAI-1 complex in the prognosis of the development of TC with a threshold value of more than 14 ng/ml and OR 11.3 (95% CI 1.18–109.3, p=0.03). Conclusion. The significance of the t-PA/PAI-1 complex and fibronectin as markers of TC in IS may be due to a violation of the activation processes of the fibrinolytic link of hemostasis and the accumulation of non-deposited compounds that damage the vascular wall. © 2022 Consilium Medikum. All rights reserved.