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Blood biomarkers for stroke

Authors
Koto Ishida, MD
Brett L Cucchiara, MD
Section Editor
Scott E Kasner, MD
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

This topic will discuss candidate blood biomarkers that may have a role in the evaluation and care of patients with stroke, as well as some of the more promising markers under investigation (table 1). Details about the clinical evaluation of stroke are reviewed elsewhere. (See "Overview of the evaluation of stroke".)

Specific blood biomarkers of autoimmune and hypercoagulable conditions relating to stroke are discussed separately. (See "Secondary prevention for specific causes of ischemic stroke and transient ischemic attack", section on 'Blood disorders'.)

GENERAL CONSIDERATIONS

While measurement of blood markers of cardiac myocyte injury such as troponin has revolutionized the evaluation and management of patients with myocardial infarction, the role of blood biomarkers in stroke remains limited. An ideal blood biomarker for stroke would be reliable, rapidly measured, and readily available, and might assist with diagnosis, determination of stroke subtype or mechanism, or prediction of outcome or response to therapy (table 2) [1].

The development of diagnostic blood biomarkers for stroke, which might help distinguish stroke from mimics, faces tremendous challenges given the heterogeneity of stroke, the presence of the blood-brain-barrier, and the complexity of brain injury. To date, individual markers have lacked sufficient sensitivity and specificity for stroke diagnosis [2]. Panels of biomarkers may hold greater promise and are under active study, though they too have yet to demonstrate sufficient accuracy to be of clinical use [3-9].

In addition to diagnosis, biomarkers might assist with identification of stroke mechanism, such as markers of cardioembolism (see 'Brain natriuretic peptide (BNP)' below), carotid atherosclerosis (see 'C-reactive protein (CRP)' below), cancer hypercoagulability (see 'D-dimer' below), and large artery atherosclerosis (see 'Lipoprotein-associated phospholipase A2 (Lp-PLA2)' below). Once validated, such biomarkers could be useful for choosing specific primary and secondary prevention strategies.

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed May 04 00:00:00 GMT+00:00 2016.
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