급성기 허혈성 뇌졸중 아형에 따른 혈장 D-dimer와 Fibrinogen/Fibrin Degradation Products의 차이
Plasma Levels of D-dimer and Fibrinogen/Fibrin Degradation Products According to Subtypes of Ischemic Stroke
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Background: Although levels of D-dimer and fibrinogen/fibrin degradation products (FDP) are low in the circulation of healthy individuals, their levels are significantly elevated in patients with thromboembolic diseases. The aim of this study was to investigate the clinical utilities of D-dimer and FDP in the early diagnosis of stroke subtypes and the prediction of early prognosis. Methods: Hospitalized patients due to acute ischemic stroke underwent measurement of plasma levels of D-dimer and FDP within 12 hours after admission. Stroke severity was assessed on admission and 2 weeks later using the National Institutes of Health Stroke Scale (NIHSS). Stroke subtypes were classified according to the criteria of the Trial of ORG 10172 in Acute Stroke Treatment criterion. Results: D-dimer and FDP levels were significantly higher in the cardioembolic group than in the atherosclerotic and lacunar groups. There was independent correlation between the level of FDP and cardioembolism. Ninety-six patients showed clinical improvement that was defined by a reduction of more than 4 points on the NIHSS two weeks later compared with that on admission. The level of D-dimer was higher in patients with clinical improvement than in patients without improvement (p=0.032). However, there was no correlation between the level of D-dimer and early improvement. Conclusions: These results show that measurement of FDP in acute ischemic stroke could be helpful in subtype classification. However, D-dimer and FDP were not related with early prognosis.
Abstract
Background: Although levels of D-dimer and fibrinogen/fibrin degradation products (FDP) are low in the circulation of healthy individuals, their levels are significantly elevated in patients with thromboembolic diseases. The aim of this study was to investigate the clinical utilities of D-dimer and FDP in the early diagnosis of stroke subtypes and the prediction of early prognosis. Methods: Hospitalized patients due to acute ischemic stroke underwent measurement of plasma levels of D-dimer and FDP within 12 hours after admission. Stroke severity was assessed on admission and 2 weeks later using the National Institutes of Health Stroke Scale (NIHSS). Stroke subtypes were classified according to the criteria of the Trial of ORG 10172 in Acute Stroke Treatment criterion. Results: D-dimer and FDP levels were significantly higher in the cardioembolic group than in the atherosclerotic and lacunar groups. There was independent correlation between the level of FDP and cardioembolism. Ninety-six patients showed clinical improvement that was defined by a reduction of more than 4 points on the NIHSS two weeks later compared with that on admission. The level of D-dimer was higher in patients with clinical improvement than in patients without improvement (p=0.032). However, there was no correlation between the level of D-dimer and early improvement. Conclusions: These results show that measurement of FDP in acute ischemic stroke could be helpful in subtype classification. However, D-dimer and FDP were not related with early prognosis.
참고문헌 (26)
- Gordon DL, "Interphysician agreement in the diagnosis of subtypes of acute ischemic stroke: implications for clinical trials. The TOAST Investigators", Neurology, 43, pp.1021~1027 (1993)
- Madden KP, "Accuracy of the initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment", Neurology, 45, pp.1975~1979 (1995)
- Wells PS, "Advances in the diagnosis of venous thromboembolism", J Thromb Thrombolysis, 21, pp.31~40 (2006)
- Moresco RN, "Association between plasma levels of D-dimer and fibrinogen", fibrin degradation products (FDP) for exclusion of thromboembolic disorders, 2006, pp.21, 199~202
- Kearon C, "An evaluation of D-Dimer in the diagnosis of pulmonary embolism: a randomized trial", Ann Intern Med, 144, pp.812~821 (2006)
- Arrive L, "D-dimer determination combined with clinical probability for the diagnosis of leg venous thrombosis", J Radiol, 83, pp.337~340 (2002)
- Lowe GD, "Fibrin D-dimer and cardiovascular risk", Semin Vasc Med, 20055, pp.387~398
- Bosson JL, "Quantitative high D-dimer value is predictive of pulmonary embolism occurrence independently of clinical score in a well-defined low risk factor population", J Thromb Haemost, 3, pp.93~99 (2005)
- Bosson JL, "Deep vein thrombosis in elderly patients hospitalized in subacute care facilities: a multicenter cross-sectional study of risk factors, prophylaxis, and prevalence", Arch Intern Med, 163, pp.2613~2618 (2003)
- Righini M, "Effects of age on the performance of common diagnostic tests for pulmonary embolism", Am J Med, 109, pp.357~361 (2000)
- de Moerloose P, "D-dimer assays for the exclusion of venous thromboembolism: which test for which diagnostic strategy", Thromb Haemost, 83, pp.180~181 (2000)
- Bounameaux H, "Plasma measurement of D-dimer as diagnostic aid in suspected venous thromboembolism: an overview", Thromb Haemost, 71, pp.1~6 (1994)
- Ageno w, "Plasma measurements of D-dimer levels for the early diagnosis of ischemic stroke subtypes", Arch Intern Med, 162, pp.2589~2593 (2002)
- Barber M, "Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression", Stroke, 35, pp.1421~1425 (2004)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of ORG 10172 in acute stroke treatment", Stroke, 24, pp.35~41 (1993)
- Richard AM, "Henry’s clinical diagnosis and management by laboratory methods. 20th ed", Saunders, pp.642~659 (2003)
- Brogan GX Jr, "Bench to bedside: Pathophysiology of acute coronary syndromes and implications for therapy", Acad Emerg med, 9, pp.1029~1044 (2002)
- Friedman M, "The pathogenesis of a coronary thrombus", Am J Pathol, 48, pp.19~44 (1966)
- Tombul T, "Hemostatic markers and platelet aggregation factors as predictive markers for type of stroke and neurological disability following cerebral infarction", J Clin Neurosci, 12, pp.429~434 (2005)
- Smith A, "Which hemostatic markers add to the predictive value of conventional risk factors for coronary heart disease and ischemic stroke", The Caephilly Study. Circulation, 112, pp.3080~3087 (2005)
- Takano K, "Markers of a hypercoagulable state following acute ischemic stroke", Stroke, 23, pp.194~198 (1992)
- Kataoka S, "Activation of thrombosis and fibrinolysis following brain infarction", J Neurol Sci, 181, pp.82~88 (2000)
- Toni D, "Acute ischemic strokes improving during the first 48 hours of onset: predictability, outcome, and possible mechanisms. A comparison with early deteriorating strokes", Stroke, 28, pp.10~14 (1997)
- Squizzato A, "D-dimer is not a long-term prognostic marker following acute cerebral ischemia", Blood Coagul Fibrinosysis, 17, pp.303~306 (2006)
- Kumagai K, "Increased intracardiovascular clotting in patients with chronic atrial fibrillation", J Am Coll Cardiol, 16, pp.377~380 (1990)
- Lip GY, "Fibrin D-dimer and beta-thromboglobulin as markers of thrombogenesis and platelet activation in atrial fibrillation. Effects of introducing ultra-low-dose warfarin and aspirin", Circulation, 94, pp.425~431 (1996)