Dynamical levels of plasma F1+2 and D-dimer in patients with acute cerebral infarction during intravenous urokinase thrombolysis

Objective: To explore the value of dynamically monitored levels of plasma prothrombin fragment(1+2) (F1+2) and D-dimer in the process of thrombolysis with urokinase. Methods: Blood samples were collected at baseline and at hours 1, 2, 3, 6, 12, 24, 48, 72, and 96 after urokinase infusion finished. The levels of plasma F1+2 and D-dimer of 45 patients who received urokinase intravenous infusion were assayed by ELISA and fluorescent immunoassay, and analysed dynamically with their clinical outcomes. Results: The levels of plasma F1+2 and D-dimer in patients before urokinase thrombolysis were significantly higher than age- and gender-matched normal controls (all p < 0.05). After urokinase infusion was finished, three kinds of dynamic changes of plasma F1+2 and D-dimer with different clinical outcomes appeared. In effective subgroup (n = 30), the plasma D-dimer increased quickly and reached to the peak at the third hour, remained at the higher level for more than 24 hours, and then decreased gradually; while plasma F1+2 began to decrease at the second hour and promptly approached to its trough near the baseline, after 24 hours. In non-effective subgroup, the D-dimer was slightly higher than its baseline and much lower than that in the effective subgroup, and the most high level appeared at the sixth hour and decreased quickly; moreover, the peak of F1+2 appeared at the third hour and remained at high level for more than 40 hours, and then decreased to the trough which was near the baseline. In cerebral hemorrhage subgroup, the D-dimer peak (2551 +/- 68 mu g/l) appeared at the third hour, which was 1.5-fold higher than that in effective subgroup (1895 +/- 89 mu g/l), 5.0-fold higher than that in non-effective subgroup (531 +/- 46 mu g/l), and 6.0-fold higher than its baseline, and kept higher level for more than 72 hours; meanwhile, the F1+2 decreased remarkably and reached the trough which was far below its baseline. Conclusions: Plasma F1+2 and D-dimer levels are closely related to the different clinical outcomes after urokinase thrombolysis. Thrombotic-fibrinolytic imbalance might be one of the main reasons which affected the prognosis of ischemia stroke. Dynamic assay of the two biomarkers in plasma besides clinical observation might be helpful to predict the early prognosis of acute ischemia stroke during the process of urokinase thrombolysis. [Neurol Res 2009; 31: 367-370]