Shanduk V. Peculiarities of the course of acute and recovery periods of atherothrombotic and cardioembolic subtypes of ischemic stroke, depending of the fibrinolysis system

The dissertation is concerned with the substantiation of the complex clinical and neurological, neurocognitive, instrumental examination and fibrinolysis system study in patients with atherothrombotic and cardioembolic subtype of ischemic stroke. It was found that the patients with cardioembolic stroke (CES) had a significantly higher mean score of NIHSS neurological deficiency when they was admitted to the hospital compared to the patients with atherothrombotic stroke (ATS), which lasted for the 14th day but was lost after 12 months observation. We know that sufficient activity of the fibrinolytic system can lead to rapid recanalization of the vessel and lead to a regression of the neurological deficiency. For this reason we analyzed the parameters of fibrinolytic activity of the blood (tissue plasminogen activator (TPA), tissue type plasminogen activator inhibitor type 1 (PAI-1), plasminogen (PG), α2-antiplasmin, XIIa-dependent fibrinolysis, total lysis time of the euglobulin clot) and revealed depression of the fibrinolysis system. A significantly lower TPA, a high concentration of PAI-1, an extended lysis time of euglobulins and Hageman-dependent fibrinolysis in the patients with CES was reported as compared to the patients with ATS. It was found that the several indices of the blood fibrinolytic activity correlated with neurological and neurocognitive deficits. Complex analysis of mortality cases in patients with ATS and CES has been carried out taking into account the parameters of the fibrinolysis system. An anti-aggregant and anticoagulant therapy, especially acetylsalicylic acid and warfarin, has been evaluated in patients with ATS and CES in order to determine the secondary prevention of stroke. The risk of mortality increased by 1.5 times in patients with CES which does not adhere to the rules of admission with warfarin. We analyzed the effect of the secondary prevention on the quality of life in patients with ATS and CES after 12 months after ischemic stroke.