Vascular-platelet hemostasis in hyperacute and acute phases of cardioembolic stroke during anticoagulant therapy: 612.115.35

Abstract

Summary. Introduction. Studying the main hemostasis markers is prognostically important for addressing complications in the acute period of cardioembolic stroke (CES) during anticoagulant therapy. Aim: to study primary hemostasis in patients with non-valvular atrial fibrillation in hyperacute and acute phases of CES during treatment with unfractionated (UFH) and low molecular weight heparins (LMWH). Materials
and Methods. We conducted a prospective observational study that included 38 patients with confirmed ischemic stroke (IS). The main group comprised 27 patients with CES aged 75.0±6.8 years, including 14 (51.9%) women. The comparison group consisted of 11 patients with non-cardioembolic stroke aged 72.0±8.0 years, including 5 (45.5%) women. On days 2–3 (hyperacute period) and days 7–10 (acute period), the state of all the patients was analyzed according to the National Institutes of Health Stroke Scale (NIHSS) and Rankin scale (RS); brain computed tomography (CT) using the Alberta Stroke Program Early CT Score (ASPECTS) was performed to evaluate early CT changes in stroke; screening Doppler ultrasonography of the brachiocephalic arteries, echocardiography, complete blood count, and blood chemistry were conducted; the values of activated partial thromboplastin time, prothrombin time, markers of vascular-platelet hemostasis — spontaneous platelet aggregation and induced platelet aggregation with various inducers (ADP, ristocetin, adrenaline, collagen, arachidonic acid) and von Willebrand factor (vWF) activity were measured. Results. During UFH treatment in the patients with CES increased platelet aggregation with ADP (p=0.020), with collagen (p=0.014) on days 2–3, with ristocetin (p=0.029) on days 7–10 was observed when compared with
the comparison group. Ristocetin-induced platelet aggregation was recorded above the normal values on days 2–3 and 7–10; vWF activity on days 2–3 was significantly higher than that in the comparison group (p=0.035). During LMWH use, 88.2% of patients had high platelet aggregation with ristocetin on days 2–3 (80.0 [73.00–84.3]%) and on days 7–10 (82.0 [75.0–88.2]%). In three patients with CES who received heparin therapy without acetylsalicylic acid (ASA) high platelet aggregation with arachidonic acid was observed. Correlations were identified between vWF activity and platelet aggregation with ristocetin (p=0.006; r=0.519), between vWF activity and platelet aggregation with collagen (p=0.030; r=0.418). Patients with CES who received heparin therapy and ASA tended to have a higher rate of hematuria (55.6%) than those who received ASA only (9.1%; p=0.010). Conclusion. Administration of UFH and LMWH in early CES did not significantly affect the changes in the neurological status and ischemic cerebral volume over time, and their use was aimed at preventing deep vein thrombosis and pulmonary embolism.

For citation: Tran M.D., Shurdumova M.Kh., Petrova E.A., Koltsova E.A., Yasamanova A.N., Avakyan G.G., Koltsov I.A. Vascular-platelet hemostasis in hyperacute and acute phases of cardioembolic stroke during anticoagulant therapy. Tromboz, gemostaz i reologiya. 2025;(2):83–94. (In Russ.).

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