BLOOD COAGULATION PROBLEMS AND THROMBOEMBOLIC COMPLICATIONS IN THE ACUTE STAGE OF STROKE

Abstract

Background: High prevalence of stroke and constant mortality which is related to thromboembolic complications in one fourth of patients make it necessary to continue evaluation of clinically precise and technologically feasible methods of adequate control of coagulation and anticoagulation systems and predicting of venous thromboses and embolism. Aim: To improve diagnostics and treatment of patients with acute stroke of various types through assessment of haemostasis system and pathophysiological mechanisms of venous thromboembolism (VTE). Materials and methods: One hundred and forty five (145) patients with acute cerebral stroke (mean age, 69±13.2 years; 75 male and 70 female) were included into the study. All patients were admitted to the neuroresuscitation unit within 6 to 24 hours from manifestation; the diagnosis was verified by multiaxial computerized tomography. One hundred and four (104) (71.7%) of patients had ischemic stroke, 41 (28.3%) of patients had hemorrhagic stroke. At admittance, all patients had a certain level of consciousness derangement. All patients were monitored by means of computerized tomography, general and neurological assessment, functional assessment, chest X-ray, ultrasound examination of extremities and assessment of haemostasis (screening and direct thrombodynamics test). Results: In 95% of cases, VTE risk factors were found; VTE developed in 40 (27.6%) of patients. The most frequent complication was pulmonary embolism (90% of all VTE and 24.8% of 145 patients). In-hospital mortality was 44.1% (n=64) and correlated with VTE (r=0.384; р<0.01). Outcomes of ischemic stroke depended mainly on VTE (at autopsy, they were found in 58.5% of patients with ischemic stroke and in 26.1% of those with hemorrhagic stroke) and other complications. Outcomes of hemorrhagic insult depended on the size of the lesion that correlated with severity of clinical symptoms. Screening coagulation parameters were not informative enough for the assessment of haemostasis. Development of VTE correlated with some hypercoagulation in the first days after stroke that were quickly transformed into hypocoagulation. This process could be reliably assessed by the thrombodynamics test. Conclusion: Taking into account high incidence of VTE in patients with severe stroke and low informative value of coagulation screening, it is reasonable to use direct methods of haemostasis assessment and individualized approached to preventive and therapeutic anticoagulation.

Keywords

• stroke
• thromboembolism
• pulmonary embolism
• deep vein thrombosis
• outcome
• anticoagulation
• thrombodynamics test