Role of fibrinolytic markers in acute stroke

Abdullah WZ, Idris SZ, Bashkar S, Hassan R
Correspondence: Dr Wan Zaidah Abdullah, wzaidah@kb.usm.my

ABSTRACT
Introduction The fibrinolytic system plays an important role in normal haemostasis and endothelial function. This study was conducted to compare three fibrinolytic markers, i.e. plasminogen, tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor type-1 (PAI-1) between acute stroke and stable non-stroke patients and to investigate the clinical significance of these markers.
Methods A prospective study was done for a one-year period upon obtaining ethical approval from the local institution. 106 non-stroke individuals from general outpatient clinics (control group) and 51 acute stroke patients were selected. All subjects were tested for t-PA and PAI-1 levels using the enzyme immunoassay technique (Biopool TintElize®) and for plasminogen level by colorimetric assay (HemosILTM). They were followed up over a period of three months for survival and neurological recovery.
Results Only the mean t-PA level was significantly higher in acute stroke patients compared to the control group, including after adjusting for confounders (using ANCOVA). There was no statistical association between the three fibrinolytic markers and the age, gender, stroke subtypes, number of risk factors, functional impairment, survival and neurological recovery. We observed that all the eight patients who died within one month of stroke onset had high levels of t-PA. An association between high t-PA antigen and acute stroke was found during a cerebrovascular event with a 4.6-fold odds ratio compared to non-stroke controls.
Conclusion High t-PA antigen in acute stroke patients probably indicates a poor prognosis. Its value as a marker for monitoring and prognostication needs to be evaluated as a routine clinical practice.

Keywords: acute stroke, plasminogen, plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA)
Singapore Med J 2009; 50(6): 604-609