Acute diagnostics before therapeutic intervention:
- Coagulation parameters – INR, Quick (prothrombin time, PT), aPTT, thrombin time.
- INR correlates with vitamin K antagonist serum concentration.
- Quick (more precise than aPPT) correlates with serum concentration of direct Factor Xa inhibitors (apixaban, edoxaban, rivaroxaban); meanwhile, a Factor Xa activity assay is also available
- Thrombin time correlates with dabigatran serum concentration.
Rule of thumb: If Quick + aPTT normal → no relevant coagulopathy due to NOAKs (new oral anticoagulants; direct oral anticoagulants, DOAKs) likely.
- Small blood count [erythrocytes; platelets]
- Electrolytes – calcium, sodium, potassium
- Fasting glucose (fasting blood sugar)
- Troponins and CK (creatinine kinase) – exclusion of myocardial damage (heart muscle damage)Note: Prognosis after apoplexy is worse the higher the troponin level in patients with a recent ischemic insult. The increased mortality (death rate) mainly affects patients in whom troponin levels rise or fall significantly in the first hours and days after the apoplexy. Approximately 50% of all apoplexy patients have coronary artery disease (CAD; coronary artery disease).
- Glomerular filtration rate (GFR) [in condition after acute apoplexy, even with normal or slightly elevated creatinine levels, renal function may already be significantly impaired]Note: Unrecognized renal insufficiency is associated with increased mortality (death rate) in patients with acute apoplexy.
- Pregnancy test (quantitative HCG) – in women of childbearing age.
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- HbA1c
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT), alkaline phosphatase, bilirubin.
- Renal parameters – urea, creatinine, cystatin C or creatinine clearance if necessary; microalbuminuria test.
- Uric acid
- Atherosclerosis parameters:
- Total cholesterol, LDL cholesterol, HDL cholesterol.
- Triglycerides
- Homocysteine
- Fibrinogen
- MOCHA profile (Markers of Coagulation and Hemostatic Activation): D-dimers as well as (measure of thrombin formation), prothrombin fragment 1. 2, thrombin-antithrombin complex, and fibrin monomer [≥ 2 markers ↑: increased risk that their stroke can be attributed to cancer, venous thromboembolism (VTE), or other conditions associated with hypercoagulability (increased blood clottability); study participants were 132 patients with cryptogenic stroke according to ESUS criteria].
Preventive laboratory diagnostics
- Lp-PLA2 (vascular inflammatory enzyme lipoprotein-associated phospholipase A2; inflammatory marker) – for risk stratification of cardiovascular disease.
- Trimethylamine oxide (TMAO), more specifically trimethylamine N-oxide (TMAO); pro-atherogenic and prothrombotic metabolite produced from gut microbiome metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine; Considered a potentially modifiable cardiovascular risk factor – predicts the risk of cardiovascular events in patients with apoplexy (stroke) and is associated with proinflammatory monocytes.
