Abstract
Alterations of platelet, coagulation, and fibrinolysis markers were investigated to
determine the indications for antithrombotic therapy in patients with different clinical
categories of acute cerebral infarction. Marked platelet activation was observed in
platelet function tests, including measurements of platelet-specific proteins and
platelet survival, platelet scintigraphy in the brain, and platelet fibrinogen binding
assay, in patients with atherothrombotic stroke. Among patients with atherothrombotic
stroke, increases of thrombin-antithrombin III complex (TAT) and D-dimer were frequent
in addition to the findings of platelet activation in patients showing progressing
stroke. Patients with cardioembolic stroke demonstrated marked elevation of coagulation
markers, TAT and fibrinopeptide A, and fibrinolysis markers, D-dimer and plasmin-α2-plasmin inhibitor complex, as well as platelet activation. In contrast, neither activation
was seen in patients with lacunar stroke. On the basis of these findings, antiplatelet
therapy is indicated for stable or improving stroke, whereas anticoagulant therapy
is indicated for progressing stroke among patients with atherothrombotic stroke. In
patients with cardioembolic stroke, anticoagulant therapy should be started as soon
as possible, or should be followed by thrombolytic therapy in the hyperacute phase.
However, further investigation appears necessary for recommendations for patients
with lacunar stroke.
Keywords:
Platelets - coagulation - fibrinolysis - cerebral infarction - antithrombotic therapy
