Antithrombin III associated with fibrinogen predicts the risk of cerebral ischemic stroke

Background and purpose: The purpose of this study is to examine the feasibility of developing plasma predictive value biomarkers of cerebral ischemic stroke before imaging evidence is acquired. Methods: Blood samples were obtained from 198 patients who attended our neurology department as emergencies - with symptoms of vertigo, numbness, limb weakness, etc. - within 4.5 h of symptom onset, and before imaging evidence was obtained and medical treatment. After the final diagnosis was made by MRI/DWI/MRA or CTA in the following 24-72 h, the above cases were divided into two groups: stroke group and non-stroke group according to the imaging results. The levels of baseline plasma antithrombin III (AT-III), thrombin-antithrombin III (TAT), fibrinogen, D-dimer and high-sensitivity C-reactive protein (hsCRP) in the two groups were assayed. Results: The level of the baseline AT-III in the stroke group was 118.07 +/- 26.22%, which was lower than that of the non-stroke group (283.83 +/- 38.39%). The levels of TAT, fibrinogen, hsCRP were 7.24 +/- 2.28 mu g/L, 5.49 +/- 0.98 g/L, and 2.17 +/- 1.07 mg/L, respectively, which were higher than those of the non-stroke group (2.53 +/- 1.23 mu g/L, 3.35 +/- 0.50 g/L, 1.82 +/- 0.67 mg/L). All the P-values were less than 0.001. The D-dimer level was 322.57 +/- 60.3411 mu g/L, which was slightly higher than that of the non-stroke group (305.76 +/- 49.52 mu g/L), but the P-value was 0.667. The sensitivities of AT-III, TAT, fibrinogen, D-dimer and hsCRP for predicting ischemic stroke tendency were 97.37%, 96.05%, 3.29%, 7.89%, but the specificity was 93.62%, 82.61%, 100% and 100%, respectively, and all the P-values were less than 0.001. High levels of D-dimer and hsCRP were mainly seen in the few cases with severe large-vessel infarction. Conclusions: Clinical manifestations of acute focal neurological deficits were associated with plasma AT-III and fibrinogen. These tests might help the risk assessment of acute cerebral ischemic stroke and/or TIA with infarction tendency in the superacute stage before positive imaging evidence is obtained. (C) 2011 Elsevier B.V. All rights reserved.