The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study
Author
Stanford, Sophia N.
Sabra, Ahmed
D'Silva, Lindsay
Lawrence, Matthew
Morris, Keith
Storton, Sharon
Brown, Martin R.
Evans, Vanessa
Hawkins, Karl
Williams, Phylip Rhodri
Davidson, Simon J.
Wani, Mushtaq
Potter, John F.
Evans, Phillip A.
Date
2015-03-15Type
Article
Publisher
BioMed Central
ISSN
1471-2377
Metadata
Show full item recordAbstract
Background
Stroke is the second largest cause of death worldwide. Hypercoagulability is a key feature in ischaemic stroke due to the development of an abnormally dense clot structure but techniques assessing the mechanics and quality of clot microstructure have limited clinical use. We have previously validated a new haemorheological technique using three parameters to reflect clot microstructure (Fractal Dimension (df)) ex-vivo, real-time clot formation time (TGP) and blood clot strength (elasticity at the gel point (G’GP)). We aimed to evaluate these novel clotting biomarkers in ischaemic stroke and changes of clot structure following therapeutic intervention.
Methods
In a prospective cohort study clot microstructure was compared in ischaemic stroke patients and a control group of healthy volunteers. Further assessment took place at 2–4 hours and at 24 hours after therapeutic intervention in the stroke group to assess the effects of thrombolysis and anti-platelet therapy.
Results
75 patients (mean age 72.8 years [SD 13.1]; 47 male, 28 female) with ischaemic stroke were recruited. Of the 75 patients, 32 were thrombolysed with t-PA and 43 were loaded with 300 mg aspirin. The following parameters were significantly different between patients with stroke and the 74 healthy subjects: df (1.760 ± .053 versus 1.735 ± 0.048, p = 0.003), TGP (208 ± 67 versus 231 ± 75, p = 0.05), G’GP (0.056 ± 0.017 versus 0.045 ± 0.014, p < 0.0001) and fibrinogen (3.7 ± 0.8 versus 3.2 ± 0.5, p < 0.00001). There was a significant decrease in df (p = 0.02), G’GP (p = 0.01) and fibrinogen (p = 0.01) following the administration of aspirin and for df (p = 0.003) and fibrinogen (p < 0.001) following thrombolysis as compared to baseline values.
Conclusion
Patients with ischaemic stroke have denser and stronger clot structure as detected by df and G’GP. The effect of thrombolysis on clot microstructure (df) was more prominent than antiplatelet therapy. Further work is needed to assess the clinical and therapeutic implications of these novel biomarkers.
Journal/conference proceeding
BMC Neurology
Citation
Stanford, S.N., Sabra, A., D’Silva, L., Lawrence, M., Morris, R.H., Storton, S., Brown, M.R., Evans, V., Hawkins, K., Williams, P.R., Davidson, S.J., Wani, M., Potter, J.F. & Evans, P.A. (2015) 'The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study', BMC Neurology, 15(1), p.1.
Description
This article was published in BMC Neurology on 15 March 2015 (online), available open access at http://dx.doi.org/10.1186/s12883-015-0289-1
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