Ischemic stroke laboratory findings

Jump to navigation Jump to search

Ischemic Stroke Microchapters

Main Stroke Page

Transient ischemic attack

Hemorrhagic Stroke Page

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Stroke from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

CT

MRI

Echocardiography

Ultrasound

Other Imaging Findings

Treatment

Early Assessment

Medical Therapy

Surgery

Rehabilitation

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

AHA/ASA Guidelines for Stroke

Case Studies

Case #1

Ischemic stroke laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Ischemic stroke laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Ischemic stroke laboratory findings

CDC on Ischemic stroke laboratory findings

Ischemic stroke laboratory findings in the news

Blogs on Ischemic stroke laboratory findings

Directions to Hospitals Treating Stroke

Risk calculators and risk factors for Ischemic stroke laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Laboratory tests which must be performed in all patients with ischemic stroke include oxygen saturation, blood glucose, serum electrolytes/renal function tests, complete blood count, including platelet count, markers of cardiac ischemia, prothrombin time/INR and activated partial thromboplastin time. Other tests may be performed in selected patient groups.

Laboratory Findings

Laboratory tests may help determine the risk factors, cause, complications and differential diagnosis of ischemic stroke. Blood tests which may be performed include:[1]

Blood test Test result Rationale
Complete blood count
  • May suggest underlying infection
  • Increased risk of thrombotic event
  • May increase the risk of bleeding in patients eligible for thrombolytic therapy[2]
Lipid profile
  • May increase the risk of thromboembolic event[3][4][5]
PT/APTT/INR
  • Increased PT/APTT/INR
  • May increase the risk of bleeding in patients eligible for anticoagualant therapy[6][2][7]
  • May suggest underlying coagulation disorder
BUN/Creatinine
  • Increased BUN and creatinine
  • Mild to moderate renal dysfunction is an independant risk factor for ischemic stroke[8][9]
  • May be associated with poor prognosis in patients with ischemic stroke[9][10]
Serum homocysteine level
  • Increased levels of serum homocysteine levels
  • May be associated with increased risk of thromboembolic event[11][12]
Basic metabolic panel
  • Increased or decreased serum NA2+, K+, Ca2+
  • May mimic or complicate patients with ischemic stroke[13][14][15]
HbA1C
  • Increased levels of HbA1c
  • May suggest control of diabetes in past few months
  • Increased levels associated with increased risk of ischemic stroke[16]
  • May be associated with poor prognosis in patients with ischemic stroke
Blood glucose levels
  • Increased or decreased levels of blood glucose
Cardiac enzymes
  • Increased serum levels of Trop I, Trop T, CK-MB
  • Elevated Trop T levels are associated with poor prognosis
  • May suggest ongoing myocardial ischemia[22]
Pregnancy test
  • Serum and urine B-HCG
  • Rule out pregnancy in all female patients with ischemic stroke since t-PA is a class C agent[23]

Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[24]

Other Diagnostic Tests

Class I
1. Only the assessment of blood glucose must precede the initiation of IV alteplase in all patients.. (Level of Evidence: B-NR)
2. Baseline electrocardiographic assessment is recommended in patients presenting with AIS but should not delay initiation of IV alteplase.(Level of Evidence: B-NR)
3. Baseline troponin assessment is recommended in patients presenting with AIS but should not delay initiation of IV alteplase or mechanical thrombectomy.(Level of Evidence: C-LD)
Class IIb
1. Usefulness of chest radiographs in the hyperacute stroke setting in the absence of evidence of acute pulmonary, cardiac, or pulmonary vascular disease is unclear. If obtained, they should not unnecessarily delay administration of IV alteplase. (Level of Evidence: B-NR)

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association[25]

Recommendations for Diagnostic Evaluation Referenced studies that support recommendations are summarized in online data supplements 1 and 2

Class I
5.   In patients with a confirmed diagnosis of symptomatic ischemic cerebrovascular disease, blood tests, including complete blood count, prothrombin time, partial thromboplastin time, glucose, HbA1c, creatinine, and fasting or non-fasting lipid profile, are recommended to gain insight into risk factors for stroke and to inform therapeutic goals(Level of Evidence: B-NR)
Class IIa
10.  In patients with cryptogenic stroke, tests for inherited or acquired hypercoagulable state, bloodstream or cerebral spinal fluid infections, infections that can cause central nervous system (CNS) vasculitis (eg, HIV and syphilis), drug use (eg, cocaine and amphetamines), and markers of systemic inflammation and genetic tests for inherited diseases associated with stroke are reason-able to perform as clinically indicated to identify contributors to or relevant risk factors for stroke. (Level of Evidence: C-LD)

References

  1. ↑ Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM; et al. (2013). "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (3): 870–947. doi:10.1161/STR.0b013e318284056a. PMID 23370205.
  2. ↑ 2.0 2.1 2.2 Fugate JE, Rabinstein AA (2015). "Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke". Neurohospitalist. 5 (3): 110–21. doi:10.1177/1941874415578532. PMC 4530420. PMID 26288669.
  3. ↑ Willey JZ, Xu Q, Boden-Albala B, Paik MC, Moon YP, Sacco RL; et al. (2009). "Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS)". Arch Neurol. 66 (11): 1400–6. doi:10.1001/archneurol.2009.210. PMC 2830863. PMID 19901173.
  4. ↑ Togha M, Gheini MR, Ahmadi B, Khashaiar P, Razeghi S (2011). "Lipid profile in cerebrovascular accidents". Iran J Neurol. 10 (1–2): 1–4. PMC 3829214. PMID 24250834.
  5. ↑ Lisak M, Demarin V, Trkanjec Z, Basić-Kes V (2013). "Hypertriglyceridemia as a possible independent risk factor for stroke". Acta Clin Croat. 52 (4): 458–63. PMID 24696996.
  6. ↑ Lee VH, Conners JJ, Cutting S, Song SY, Bernstein RA, Prabhakaran S (2014). "Elevated international normalized ratio as a manifestation of post-thrombolytic coagulopathy in acute ischemic stroke". J Stroke Cerebrovasc Dis. 23 (8): 2139–44. doi:10.1016/j.jstrokecerebrovasdis.2014.03.021. PMID 25081309.
  7. ↑ Miller DJ, Simpson JR, Silver B (2011). "Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies". Neurohospitalist. 1 (3): 138–47. doi:10.1177/1941875211408731. PMC 3726129. PMID 23983849.
  8. ↑ Koren-Morag N, Goldbourt U, Tanne D (2006). "Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease". Neurology. 67 (2): 224–8. doi:10.1212/01.wnl.0000229099.62706.a3. PMID 16864812.
  9. ↑ 9.0 9.1 Hao Z, Yang C, Liu M, Wu B (2014). "Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: a systematic review and meta-analysis". Medicine (Baltimore). 93 (28): e286. doi:10.1097/MD.0000000000000286. PMC 4603096. PMID 25526464.
  10. ↑ Laible M, Horstmann S, Rizos T, Rauch G, Zorn M, Veltkamp R (2015). "Prevalence of renal dysfunction in ischaemic stroke and transient ischaemic attack patients with or without atrial fibrillation". Eur J Neurol. 22 (1): 64–9, e4–5. doi:10.1111/ene.12528. PMID 25091540.
  11. ↑ Yao ES, Tang Y, Xie MJ, Wang MH, Wang H, Luo X (2016). "Elevated Homocysteine Level Related to Poor Outcome After Thrombolysis in Acute Ischemic Stroke". Med Sci Monit. 22: 3268–73. PMC 5034885. PMID 27629768.
  12. ↑ Ashjazadeh N, Fathi M, Shariat A (2013). "Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes". Iran J Med Sci. 38 (3): 233–9. PMC 3808947. PMID 24174694.
  13. ↑ Alam MN, Uddin MJ, Rahman KM, Ahmed S, Akhter M, Nahar N; et al. (2012). "Electrolyte changes in stroke". Mymensingh Med J. 21 (4): 594–9. PMID 23134903.
  14. ↑ Guven H, Cilliler AE, Koker C, Sarikaya SA, Comoglu SS (2011). "Association of serum calcium levels with clinical severity of acute ischemic stroke". Acta Neurol Belg. 111 (1): 45–9. PMID 21510233.
  15. ↑ Farahmand F, Choobi Anzali B, Heshmat R, Ghafouri HB, Hamedanchi S (2013). "Serum Sodium and Potassium Levels in Cerebro-vascular Accident Patients". Malays J Med Sci. 20 (3): 39–43. PMC 3743980. PMID 23966823.
  16. ↑ Oh HG, Rhee EJ, Kim TW, Lee KB, Park JH, Yang KI; et al. (2011). "Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults". Diabetes Metab J. 35 (5): 551–7. doi:10.4093/dmj.2011.35.5.551. PMC 3221032. PMID 22111048.
  17. ↑ Kagansky N, Levy S, Knobler H (2001). "The role of hyperglycemia in acute stroke". Arch Neurol. 58 (8): 1209–12. PMID 11493160.
  18. ↑ Bruno A, Liebeskind D, Hao Q, Raychev R, UCLA Stroke Investigators (2010). "Diabetes mellitus, acute hyperglycemia, and ischemic stroke". Curr Treat Options Neurol. 12 (6): 492–503. doi:10.1007/s11940-010-0093-6. PMC 2943579. PMID 20848328.
  19. ↑ Baker L, Juneja R, Bruno A (2011). "Management of hyperglycemia in acute ischemic stroke". Curr Treat Options Neurol. 13 (6): 616–28. doi:10.1007/s11940-011-0143-8. PMID 21861124.
  20. ↑ Gilmore RM, Stead LG (2006). "The role of hyperglycemia in acute ischemic stroke". Neurocrit Care. 5 (2): 153–8. PMID 17099262.
  21. ↑ Radermecker RP, Scheen AJ (2010). "Management of blood glucose in patients with stroke". Diabetes Metab. 36 Suppl 3: S94–9. doi:10.1016/S1262-3636(10)70474-2. PMID 21211743.
  22. ↑ Norris JW, Hachinski VC, Myers MG, Callow J, Wong T, Moore RW (1979). "Serum cardiac enzymes in stroke". Stroke. 10 (5): 548–53. PMID 505497.
  23. ↑ Grear KE, Bushnell CD (2013). "Stroke and pregnancy: clinical presentation, evaluation, treatment, and epidemiology". Clin Obstet Gynecol. 56 (2): 350–9. doi:10.1097/GRF.0b013e31828f25fa. PMC 3671374. PMID 23632643.
  24. ↑ Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K; et al. (2019). "Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 50 (12): e344–e418. doi:10.1161/STR.0000000000000211. PMID 31662037.
  25. ↑ Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D; et al. (2021). "2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association". Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check |pmid= value (help).


Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Ischemic_stroke_laboratory_findings&oldid=1735930"