Johann Otto Pelz1, Kristian Harms2, Michael Metze3, Dominik Michalski4. 1. Department of Neurology, University of Leipzig, Leipzig, Germany. johann.pelz@medizin.uni-leipzig.de. 2. Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. 3. Department of Cardiology, University of Leipzig, Leipzig, Germany. 4. Department of Neurology, University of Leipzig, Leipzig, Germany.
Abstract
BACKGROUND: Spontaneous cervical artery dissections (sCAD) are often preceded by infections. However, existing data about inflammatory parameters remained inconsistent. Remarkably, concurrent information about the coagulation system, whose affection seems also reasonable to cause ischaemic events, are still lacking in sCAD patients. Thus, this study explores the association between the inflammatory and coagulation system in patients with sCAD. METHODS: The parameters leukocyte and thrombocyte count, C-reactive protein, fibrinogen, D-dimer, activated partial thromboplastin time (aPTT) and prothrombin time were extracted from hospital-based medical records of patients (n = 60) with sCAD and compared with those of a control group (n = 97) from a prospective observational stroke study. Univariate analyses were added by multiple regression analyses. RESULTS: As compared with the control group, patients with sCAD had an increased leucocyte count (9.2 ± 3.2 vs. 7.9 ± 2.2 × 109/l; p = 0.003), an increased thrombocyte count (252 ± 52 vs. 229 ± 64 × 109/l; p = 0.021), a shortened aPTT 28.0 ± 3.5 vs. 29.9 ± 3.6 s; p = 0.001) and decreased D-dimer values (0.44 ± 0.29 vs. 0.76 ± 0.73 mg/l; p = 0.002). However, in multiple regression analyses adjusted for age, sex, initial stroke severity, arterial hypertension, diabetes mellitus and smoking only the shortened aPTT remained statistically significant (p = 0.045) between groups, while differences on leucocyte count (p = 0.087), thrombocyte count (p = 0.234) and D-dimer (p = 0.321) failed statistical significance. CONCLUSION: We found evidence for a hypercoagulable state in patients with sCAD as indicated by a shortened aPTT, which was associated with a trend to an increased leucocyte count at the same time. Our findings first strengthen the hypothesis that inflammation critically impacts on the occurrence of sCAD, and second linked this condition with a marked affection of the coagulation system.
BACKGROUND: Spontaneous cervical artery dissections (sCAD) are often preceded by infections. However, existing data about inflammatory parameters remained inconsistent. Remarkably, concurrent information about the coagulation system, whose affection seems also reasonable to cause ischaemic events, are still lacking in sCAD patients. Thus, this study explores the association between the inflammatory and coagulation system in patients with sCAD. METHODS: The parameters leukocyte and thrombocyte count, C-reactive protein, fibrinogen, D-dimer, activated partial thromboplastin time (aPTT) and prothrombin time were extracted from hospital-based medical records of patients (n = 60) with sCAD and compared with those of a control group (n = 97) from a prospective observational stroke study. Univariate analyses were added by multiple regression analyses. RESULTS: As compared with the control group, patients with sCAD had an increased leucocyte count (9.2 ± 3.2 vs. 7.9 ± 2.2 × 109/l; p = 0.003), an increased thrombocyte count (252 ± 52 vs. 229 ± 64 × 109/l; p = 0.021), a shortened aPTT 28.0 ± 3.5 vs. 29.9 ± 3.6 s; p = 0.001) and decreased D-dimer values (0.44 ± 0.29 vs. 0.76 ± 0.73 mg/l; p = 0.002). However, in multiple regression analyses adjusted for age, sex, initial stroke severity, arterial hypertension, diabetes mellitus and smoking only the shortened aPTT remained statistically significant (p = 0.045) between groups, while differences on leucocyte count (p = 0.087), thrombocyte count (p = 0.234) and D-dimer (p = 0.321) failed statistical significance. CONCLUSION: We found evidence for a hypercoagulable state in patients with sCAD as indicated by a shortened aPTT, which was associated with a trend to an increased leucocyte count at the same time. Our findings first strengthen the hypothesis that inflammation critically impacts on the occurrence of sCAD, and second linked this condition with a marked affection of the coagulation system.
Authors: C A Molina; J Alvarez-Sabín; W Schonewille; J Montaner; A Rovira; S Abilleira; A Codina Journal: Neurology Date: 2000-12-12 Impact factor: 9.910
Authors: Avi Shimony; Kristian B Filion; Salvatore Mottillo; Tara Dourian; Mark J Eisenberg Journal: Am J Cardiol Date: 2011-02-04 Impact factor: 2.778
Authors: Stéphanie Debette; Barbara Goeggel Simonetti; Sabrina Schilling; Juan José Martin; Manja Kloss; Hakan Sarikaya; Ingrid Hausser; Stefan Engelter; Tiina M Metso; Alessandro Pezzini; Vincent Thijs; Emmanuel Touzé; Stefano Paolucci; Paolo Costa; Maria Sessa; Yves Samson; Yannick Béjot; Ayse Altintas; Antti J Metso; Dominique Hervé; Christoph Lichy; Simon Jung; Urs Fischer; Chantal Lamy; Armin Grau; Hugues Chabriat; Valeria Caso; Philippe A Lyrer; Christian Stapf; Turgut Tatlisumak; Tobias Brandt; Elisabeth Tournier-Lasserve; Dominique P Germain; Michael Frank; Ralf W Baumgartner; Caspar Grond-Ginsbach; Marie-Germaine Bousser; Didier Leys; Jean Dallongeville; Anna Bersano; Marcel Arnold Journal: Neurology Date: 2014-10-29 Impact factor: 9.910
Authors: Savino Sciascia; Giovanni Sanna; Munther A Khamashta; Maria Jose Cuadrado; Doruk Erkan; Laura Andreoli; Maria Laura Bertolaccini Journal: Ann Rheum Dis Date: 2014-06-18 Impact factor: 19.103
Authors: Eliza C Miller; Hajere J Gatollari; Gloria Too; Amelia K Boehme; Lisa Leffert; Mitchell S V Elkind; Joshua Z Willey Journal: JAMA Neurol Date: 2016-12-01 Impact factor: 18.302
Authors: J Scott McNally; Peter J Hinckley; Akihiko Sakata; Laura B Eisenmenger; Seong-Eun Kim; Adam H De Havenon; Edward P Quigley; Eli Iacob; Gerald S Treiman; Dennis L Parker Journal: Stroke Date: 2018-10 Impact factor: 7.914
Authors: Johann Otto Pelz; Katharina Kubitz; Manja Kamprad-Lachmann; Kristian Harms; Martin Federbusch; Carsten Hobohm; Dominik Michalski Journal: Front Neurol Date: 2021-11-08 Impact factor: 4.003