Author + information
- Received January 15, 2008
- Revision received March 14, 2008
- Accepted April 16, 2008
- Published online September 2, 2008.
- ↵⁎Reprint requests and correspondence:
Dr. Marco R. Di Tullio, Columbia University Medical Center, PH3-342, 622 West 168th Street, New York, New York 10032
Objectives Our goal was to assess the effect of hypercoagulability on the risk of stroke in patients with aortic plaques.
Background Atherosclerotic plaques in the aortic arch are a risk factor for ischemic stroke. Their relationship with blood hypercoagulability, which might enhance their embolic potential and affect treatment and prevention, is not known.
Methods We performed transesophageal echocardiography in 255 patients with first acute ischemic stroke and in 209 control subjects matched by age, gender, and race/ethnicity. The association between arch plaques and hypercoagulability, and its effect on the stroke risk, was assessed with a case-control design. Stroke patients were then followed prospectively to assess recurrent stroke and death.
Results Large (≥4 mm) arch plaques were associated with increased stroke risk (adjusted odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.3 to 4.6), especially when ulcerations or superimposed thrombus were present (adjusted OR: 3.3, 95% CI: 1.4 to 8.2). Prothrombin fragment F 1.2, an indicator of thrombin generation, was associated with large plaques in stroke patients (p = 0.02), but not in control subjects. Over a mean follow-up of 55.1 ± 37.2 months, stroke patients with large plaques and F 1.2 over the median value had a significantly higher risk of recurrent stroke and death than those with large plaques but lower F 1.2 levels (230 events per 1,000 person-years vs. 85 events per 1,000 person-years; p = 0.05).
Conclusions In patients presenting with acute ischemic stroke, large aortic plaques are associated with blood hypercoagulability, suggesting a role for coagulation activation in the stroke mechanism. Coexistence of large aortic plaques and blood hypercoagulability is associated with an increased risk of recurrent stroke and death.
The study was supported by R01 NS36286 from the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Di Tullio was the recipient of an NINDS Mid-Career Award in Patient-Oriented Research (K24 NS02241).
- Received January 15, 2008.
- Revision received March 14, 2008.
- Accepted April 16, 2008.
- American College of Cardiology Foundation