The Abnormality Of Coagulation And Fibrinolysis On Patient With Transient Ischemic Attacks

Objective Transient ischemic attacks is a common neurology disease, one risk factor of ischemic stroke. At present there are two theories that cause the brief interruption of local cerebral blood flow: blood clots within a mini-artery that temporarily block arteries carrying blood and oxygen to the brain or abnormal dynamic bloodstream that causes decreased supply of blood for brain. In recent years more and more evidence indicated that the risk of subsequent stroke is higher than was previously supposed, with the reports of 7-day stroke risks up to 10%, and the time-window for prevention of subsequent stroke is very short, so the evaluation of the risk factors of subsequent stoke become the most important aspect for the diagnosis and further treatment. But recent risk-factors studies have provided some useful data about overall evaluation of its clinical symptom that provide evidence for prognosis, but the research about the important mechanism of resulting to permanent ischemic stroke is absent. The correct and effective therapy bases on the thorough recognition of its cause. Foreign research reported that there were abnormalities of coagulation -fibrolysis system on patient with acute transient ischemic attacks. The study was to investigate the effect of the endotheliocyte injury and the abnormalities of coagulation -fibrolysis system on the advancement of the disease,and analysize the value of all the melocular makers in the diagnosis of the severity and prethrombotic by measuring the level of von Willebrand factor (vWF), fibrin peptide A (FPA), tissue type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI) and D- Dimer with enzyme linked immunosorbent assay and chromogenic substrates.Method 50 hospitalized patients with acute transient ischemic attack (≤3 days) were selected in Emergency and neurology department from September 2005 to August 2006 randomly.Analysizing their clinincal datas,the TIAs was divided into two groups according to "6 Scores-ABCD" grade criterion: high-risk group(the ABCD point ≧ 5)18 examples; low-risk group(the ABCD point < 5)32 examples. measuring the level of von Willebrand factor (vWF), fibrin peptide A(FPA) with enzyme linked immunosorbent assay, tissue type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI) with chromogenic substrates and D- Dimer was supplied by laboratory,compared with 30 normal controls with t test.And all the index have been done the analysis of correlation between the two groups.Result (1)The plasma levels of vWF, FPA, β-TG, D-dimer and PAI activity were found to be significantly elevated in the TIAs compared with the normal controls (p < 0.01) ,and t-PA activity was lower than the controls, these difference achieved statistical significance.(2) In the TIAs, the level of vWF, D-dimer and PAI activity in the high-risk groups was significantly higher than the low-risk groups ,but the differences of FPA and t-PA did not achieve statistical significance.(3)The correlation of the index on the TIAs is higher than the controls' .(4)In the TIAs,the vWF has the significant positive correlation with FPA, t-PA and D-dimmer.Conclusion (1) The patients of TIA usually exist vascular endothelial injury, hypercoagulability and formation of mini-thrombosis, the plasma levels of vWF, FPA, t-PA, PAI, D-dimer may reflect to some certain extent coagulation changes in TIAs.(2)The measurement of vWF, D-dimer and PAI activity in TIAs is usefull for early judgement of the prognosis and provide basis for the early treatment.(3)To the TIAs, the ABCD score can be used in routine clinical practice to identify high-risk individuals who need emergency investigation and treatment, but it is not sufficient to detect routine state of coagulation, and the detection of prethrombotic state should become the rule, so that we can analyze the condition of the patient totally.(4)The correlation of the TIAs' indexes is higher than the controls', so the activation of the Coagulation and fibrinolysis is a continuous process. There has been a complicated pathophysiological procedure.(5)From the correlation analysis of the index, the injury of the endotheliocyte play important role in the progress of the disease.