Early markers of thrombotic hazard in cerebrovascular diseases

Introduction. Cerebrovascular disease (CVD) is a heterogeneous group of difficult-to-diagnose conditions in which hemorheological and hemostatic disorders significantly impact the risk of ischemic stroke (IS), as well as the prognosis and response to reperfusion therapy and preventive treatment. Laboratory thrombotic hazard markers, such as the thrombin-antithrombin III (TAT) complex, the plasmin-α2-antiplasmin (PAP) complex, thrombomodulin (TM), and the tissue plasminogen activator (tPA)/plasminogen activator inhibitor-1 (PAI-1) activity ratio, have not been adequately evaluated as predictors of different IS subtypes. Their potential role in acute IS has also not been determined. Aim. The study aimed to evaluate the diagnostic and predictive value of primary thrombotic hazard markers in patients with CVD. Materials and methods. The retrospective study included 91 patients with acute IS (45% of men; median age: 62 years). At admission, primary clinical parameters were assessed, including a National Institutes of Health Stroke Scale (NIHSS) score. Laboratory parameters and thrombotic hazard markers were also measured using an enzyme-linked immunosorbent assay. Three IS subtypes included large artery atherosclerosis (LAA)-related IS (n = 32), lacunar IS (n = 27), and hemorheological (small artery occlusion-related) IS (n = 32). The clinical outcomes were evaluated at day 10 using the NIHSS scale. A comparison group included patients with chronic CVD (n = 29; 34% men; median age: 55 years). Results. The plasma levels of almost all study biomarkers differed significantly between patients with IS and chronic CVD, as well as between patients with different IS subtypes. Four of six markers (PAI-1, PAP, TAT, t-PA/PAI-1) were significantly associated with IS development, with TAT showing the strongest association (odds ratio: 4.78; 95% confidence interval: 2.70, 9.68). Linear regression models were used to evaluate the predictive value of thrombotic hazard biomarkers for IS outcomes, and TAT showed the most significant association in this case (p 0.001). An analysis of the differential value of study biomarkers for different IS subtypes showed that PAI-1 was the most sensitive (0.969) marker for LAA-related IS, while t-PA/PAI-1 (0.99) and TAT (0.889) demonstrated high predictive value for lacunar IS. Conclusion. Thrombotic hazard markers are a promising laboratory tool for evaluating IS risk and predicting functional outcomes and response to reperfusion therapy in patients with IS.