Thrombin generation is associated with ischemic stroke at a young age

Samantha J. Donkel, Karmen Pater, Frank W.G. Leebeek, Diederik W.J. Dippel, Hugo ten Cate, Moniek P.M. de Maat*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Introduction: Understanding the underlying mechanisms in ischemic stroke (IS) in young adults remains challenging. Thrombin activates processes that contribute to the development and progression of arterial diseases. We investigated the association between thrombin generation (TG) and a first IS or transient ischemic attack (TIA) in young adults. Methods: In this case-control study, we included consecutive patients (≤45 years in men, ≤55 years in women) with a first IS or TIA (n = 160) and healthy controls (n = 160). TG was determined with the calibrated automated thrombogram (CAT) assay. Logistic regression was used to analyze the association between TG and IS. Men and women were analyzed separately. Results: TG started earlier, reached its peak earlier and was also terminated earlier in patients than in healthy controls. Peak height (PH) was higher in patients than in controls, 227 nM (25th–75th percentile 145–326) versus 179 nM (110–294), p = 0.02. The endogenous thrombin potential (ETP) was not different in patients and controls, 1530 nM·min (1089–2045) versus 1454 nM·min (1011–2139), p = 0.52. Lag time (LT) (Odds Ratio (OR) 0.91 (95% confidence interval (CI) 0.83–0.99)), time to peak (TTP) (OR 0.91, 95% CI 0.84–0.97) and time to tail (TTT) (OR 0.92, 95% CI 0.88–0.97) were associated with a first IS and TIA. In men LT, TTP and TTT were associated with IS, but not in women. Conclusions: We found that TG parameters are associated with a first IS in young patients. Further prospective studies are warranted to elucidate the role of TG in IS.

Original languageEnglish
Pages (from-to)139-144
Number of pages6
JournalThrombosis Research
Early online date29 Mar 2021
Publication statusPublished - 1 Jun 2021

Bibliographical note

Funding Information:
The ATTAC study was supported by a MRACE grant of the Erasmus MC, Rotterdam, the Netherlands. We acknowledge the support of the Netherlands Cardiovascular Research Initiative which is supported by the Dutch Heart Foundation (CVON2015-01: CONTRAST), the support of the Brain Foundation Netherlands (HA2015.01.06), and the support of Health~Holland, Top Sector Life Sciences & Health (LSHM17016), Medtronic and Cerenovus. The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.

Publisher Copyright:
© 2021


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