https://doi.org/10.4081/vl.2024.12592
Shortened activated partial thromboplastin time could be an independent risk factor for acute ischemic stroke: a preliminary study
Submitted: 21 April 2024
Accepted: 24 August 2024
Published: 3 October 2024
Accepted: 24 August 2024
Abstract Views: 279
PDF: 61
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Alterations in hemostasis are linked to the development of ischemic stroke. Intrinsic coagulation pathway activity is typically assessed via Activated Partial Thromboplastin Time (APTT). This study investigates the association between shortened APTT duration and ischemic stroke development.
This retrospective case-control study included 85 patients with acute ischemic stroke who were admitted to the Ibb University-affiliated Hospitals, from Jun 2022 to Sept 2023 and 35 control subjects with no history of stroke. Shortened APTT was defined with a duration lower than 28.4 seconds. Multivariate analysis was conducted analyzing factors associated with acute ischemic stroke using Odds Ratio (OR) and 95% Confidence Interval (CI).
The mean age of control subjects and acute ischemic stroke cases was 40.69±8.28 years and 62.08±12.19 years, with female gender present in 10 (28.6%) and 41(48.2%) respectively. In the multivariate regression, advanced age (OR: 1.21; 95% CI: 1.13-1.30), APTT less than 28.4 seconds (OR: 7.61; 95% CI: 2.85-20.32), hypertension (OR: 28.74; 95% CI: 6.45-128.04), diabetes mellitus (OR: 10.96; 95% CI: 4.06-29.59), family history of cerebrovascular disease (OR: 13.37; 95% CI:1.73-103.27), current smoking status (OR: 2.48; 95% CI:1.09-5.64), higher cholesterol level (OR: 1.01; 95% CI:1.00-1.02), higher triglycerides level (OR: 1.05; 95% CI:1.03-1.08), and higher LDL level (OR: 1.07 95% CI:1.04-1.10) were predictive factors for acute ischemic stroke occurrence and were statistically significant (all p<0.05).
The study confirms advanced age, history of hypertension, cerebrovascular disease, diabetes mellitus, current smoking status, and higher Low-Density Lipoprotein (LDL), cholesterol, and triglycerides levels, as factors associated with increased risk of acute ischemic stroke occurrence. The possible predictive role of shortened APTT in patients with acute ischemic stroke seems to be interesting and warrants further studies in this direction.
Mattson MP, Duan W, Pedersen WA, Culmsee C. Neurodegenerative disorders and ischemic brain diseases. Apoptosis. 2001;6:69-81.
DOI: https://doi.org/10.1023/A:1009676112184
Woodruff TM, Thundyil J, Tang SC, et al. Pathophysiology, treatment, and animal and cellular models of human ischemic stroke. Mol Neurodegener. 2011;6:11.
DOI: https://doi.org/10.1186/1750-1326-6-11
Boekholdt SM, Kramer MH. Arterial thrombosis and the role of thrombophilia. Semin Thromb Hemost. 2007;33:588-96.
DOI: https://doi.org/10.1055/s-2007-985755
Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120:439-48.
DOI: https://doi.org/10.1161/CIRCRESAHA.116.308413
Kelly-Hayes M. Influence of age and health behaviors on stroke risk: lessons from longitudinal studies. J Am Geriatr Soc. 2010;58:S325-8.
DOI: https://doi.org/10.1111/j.1532-5415.2010.02915.x
Siegerink B, Govers-Riemslag JW, Rosendaal FR, et al. Intrinsic coagulation activation and the risk of arterial thrombosis in young women: results from the Risk of Arterial Thrombosis in relation to Oral contraceptives (RATIO) case-control study. Circulation. 2010;122:1854-61.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.943738
Khare S. Risk factors of transient ischemic attack: An overview. J Midlife Health. 2016;7:2-7.
DOI: https://doi.org/10.4103/0976-7800.179166
Grover SP, Mackman N. Intrinsic Pathway of Coagulation and Thrombosis. Arterioscler Thromb Vasc Biol. 2019;39:331-8.
DOI: https://doi.org/10.1161/ATVBAHA.118.312130
Salomon O, Steinberg DM, Koren-Morag N, et al. Reduced incidence of ischemic stroke in patients with severe factor XI deficiency. Blood. 2008;111:4113-7.
DOI: https://doi.org/10.1182/blood-2007-10-120139
Smith SA, Travers RJ, Morrissey JH. How it all starts: Initiation of the clotting cascade. Crit Rev Biochem Mol Biol. 2015;50:326-36.
DOI: https://doi.org/10.3109/10409238.2015.1050550
Ovanesov MV, Ananyeva NM, Panteleev MA, et al. Initiation and propagation of coagulation from tissue factor-bearing cell monolayers to plasma: initiator cells do not regulate spatial growth rate. J Thromb Haemost. 2005;3:321-31.
DOI: https://doi.org/10.1111/j.1538-7836.2005.01128.x
Lin CH, Kuo YW, Kuo CY, et al. Shortened Activated Partial Thromboplastin Time Is Associated With Acute Ischemic Stroke, Stroke Severity, and Neurological Worsening. J Stroke Cerebrovasc Dis. 2015;24:2270-6.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.008
Johnson JY, Rowe BH, Allen RW, et al. A case-control study of medium-term exposure to ambient nitrogen dioxide pollution and hospitalization for stroke. BMC Public Health. 2013;13:368.
DOI: https://doi.org/10.1186/1471-2458-13-368
Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:2064-89.
DOI: https://doi.org/10.1161/STR.0b013e318296aeca
Jin G, Hu W, Zeng L, et al. Development and verification of a nomogram for predicting short-term mortality in elderly ischemic stroke populations. Sci Rep. 2023;13:12580.
DOI: https://doi.org/10.1038/s41598-023-39781-4
Kate M, Szkotak A, Witt A, et al. Proposed approach to thrombolysis in dabigatran-treated patients presenting with ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23:1351-5.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.013
Ryu WS, Schellingerhout D, Jeong SW, et al. Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016;25:2024-30.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.05.009
Patil S, Rossi R, Jabrah D, Doyle K. Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. Front Med Technol. 2022;4:748949.
DOI: https://doi.org/10.3389/fmedt.2022.748949
Bendapudi PK, Deceunynck K, Koseoglu S, et al. Stimulated Platelets but Not Endothelium Generate Thrombin Via a Factor XIIa-Dependent Mechanism Requiring Phosphatidylserine Exposure. Blood. 2016;128:258.
DOI: https://doi.org/10.1182/blood.V128.22.258.258
Lippi G, Favaloro EJ. Activated partial thromboplastin time: new tricks for an old dogma. Semin Thromb Hemost. 2008;34:604-11.
DOI: https://doi.org/10.1055/s-0028-1104539
Tripodi A, Mannucci PM. Activated partial thromboplastin time (APTT). New indications for an old test? J Thromb Haemost. 2006;4:750-1.
DOI: https://doi.org/10.1111/j.1538-7836.2006.01857.x
McKenna R, Bachmann F, Miro-Quesada M. Thrombo-embolism in patients with abnormally short activated partial thromboplastin time. Thromb Haemost. 1977;38:893-9.
DOI: https://doi.org/10.1055/s-0038-1651907
Reddy NM, Hall SW, MacKintosh FR. Partial thromboplastin time: prediction of adverse events and poor prognosis by low abnormal values. Arch Intern Med. 1999;159:2706-10.
DOI: https://doi.org/10.1001/archinte.159.22.2706
Madi AM, Greci LS, Nawaz H, Katz DL. The activated partial thromboplastin time in early diagnosis of myocardial infarction. Blood Coagul Fibrinolysis. 2001;12:495-9.
DOI: https://doi.org/10.1097/00001721-200109000-00011
Bick RL. Disseminated intravascular coagulation: pathophysiological mechanisms and manifestations. Semin Thromb Hemost. 1998;24:3-18.
DOI: https://doi.org/10.1055/s-2007-994971
ten Boekel E, de Kieviet W, Bartels PC. Subjects with a shortened activated partial thromboplastin time show increased in-hospital mortality associated with elevated D-dimer, C-reactive protein and glucose levels. Scand J Clin Lab Invest. 2003;63:441-8.
DOI: https://doi.org/10.1080/00365510310002338
Pinelli A, Trivulzio S, Rossoni G. Activated partial thromboplastin time correlates with methoxyhydroxyphenylglycol in acute myocardial infarction patients: therapeutic implications for patients at cardiovascular risk. In Vivo. 2014;28:99-104.
Kim Y, Kim CK, Jung S, et al. Prognostic importance of weight change on short-term functional outcome in acute ischemic stroke. Int J Stroke. 2015;10:62-8.
DOI: https://doi.org/10.1111/ijs.12554
Azeez TA, Durotoluwa IM, Makanjuola AI. Diabetes Mellitus as a risk factor for stroke among Nigerians: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev. 2023;18:200189.
DOI: https://doi.org/10.1016/j.ijcrp.2023.200189
Ferrari F, Moretti A, Villa RF. Hyperglycemia in acute ischemic stroke: physiopathological and therapeutic complexity. Neural Regen Res. 2022;17:292-9.
DOI: https://doi.org/10.4103/1673-5374.317959
Liao D, Myers R, Hunt S, et al. Familial history of stroke and stroke risk. The Family Heart Study. Stroke. 1997;28:1908-12.
DOI: https://doi.org/10.1161/01.STR.28.10.1908
Imes CC, Lewis FM. Family history of cardiovascular disease, perceived cardiovascular disease risk, and health-related behavior: a review of the literature. J Cardiovasc Nurs. 2014;29:108-29.
DOI: https://doi.org/10.1097/JCN.0b013e31827db5eb
Błaż M, Sarzyńska-Długosz I. Family history of stroke - a useful clue for the primary care physician and stroke neurologist: a narrative review. Postep Psychiatr Neurol. 2023;32:31-9.
DOI: https://doi.org/10.5114/ppn.2023.126482
Tsankof A, Tziomalos K. The Role of Lipid-Lowering Treatment in the Secondary Prevention of Ischemic Stroke. Diseases. 2021;10.
DOI: https://doi.org/10.3390/diseases10010003
Amarenco P, Labreuche J, Touboul PJ. High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review. Atherosclerosis. 2008;196:489-96.
DOI: https://doi.org/10.1016/j.atherosclerosis.2007.07.033
Mahajan N, Ference BA, Arora N, et al. Role of non-high-density lipoprotein cholesterol in predicting cerebrovascular events in patients following myocardial infarction. Am J Cardiol. 2012;109:1694-9.
DOI: https://doi.org/10.1016/j.amjcard.2012.02.010
Qian Y, Ye D, Wu DJ, et al. Role of cigarette smoking in the development of ischemic stroke and its subtypes: a Mendelian randomization study. Clin Epidemiol. 2019;11:725-31.
DOI: https://doi.org/10.2147/CLEP.S215933
Linden AB, Clarke R, Hammami I, et al. Genetic associations of adult height with risk of cardioembolic and other subtypes of ischemic stroke: A mendelian randomization study in multiple ancestries. PLoS Med. 2022;19:e1003967.
DOI: https://doi.org/10.1371/journal.pmed.1003967
Ali WM, Zubaid M, Al-Motarreb A, et al. Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome. Mayo Clin Proc. 2010;85:974-80.
DOI: https://doi.org/10.4065/mcp.2010.0398
How to Cite
Abdo, B., Abdullah, M., Ahmed, F., Alzanen, K., Alawdi, R., Alhakamy, M., Alshoaibi, I., Almogahed, M., & Badheeb, M. (2024). Shortened activated partial thromboplastin time could be an independent risk factor for acute ischemic stroke: a preliminary study. Veins and Lymphatics, 13. https://doi.org/10.4081/vl.2024.12592
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