Early prognostic factors in ischemic stroke : The role of protein C and protein S

Abstract

Background and Purpose: Protein C and protein S have been found reduced in some patients with ischemic cerebrovascular diseases, but the relevance of this finding for prognosis is unsettled. Methods: In 43 consecutive patients admitted over 6 months for acute ischemic stroke, protein C and free protein S were evaluated on admission, and at 2 and 6 months after stroke. Excluded were all patients with known causes liable to reduce the levels of protein C, free protein S, or both. Results: In 14% of patients, abnormally low levels of protein C were found at entry. In comparison to the remaining sample, this group had a significantly lower initial score on the Barthel and Canadian neurological scales, a higher prevalence of emboligenic cardiac diseases, and had a higher mortality at 6 months. No statistical difference was found for the other vascular risk factors. Eight patients (18.4%) had abnormally low levels of free protein S at entry. In comparison to the remaining sample, there was no statistical difference in the severity scores, prevalence of emboligenic cardiac diseases, mortality, or vascular risk factors. Conclusions: These findings suggest that low levels of protein C in the acute stroke reflect the massive activation of coagulation factors and are predictive of adverse outcome, whereas the significance of low levels of free protein S remains to be clarified. © 1993 American Heart Association, Inc.