Assessment of the Diagnostic Value of Plasma Level of Von Willebrand Factor and ADAMTS13 in Patients with Cerebral Infarction

Abstract

Background: Von Willebrand Factor (VWF) is a large multimeric plasma gly-coprotein that plays an important role in primary haemostasis. VWF together with ADAMTS13 plays a key role in arterial thrombosis. VWF is integral for platelet adhesion to collagen fibres and atherosclerotic plaues and platelets aggregation under high shear conditions. Upon vascular wall damage, plasma VWF binds to collagen in the exposed endothelial matrix and platelet glycoprotein triggers platelet aggregation and thrombous formation. In the early stages of acute ischaemic stroke, VWF increased significantly and the ADAMTS13 level decreased. The increase of plasma VWF and FVIII in a patient with ischaemic stroke indicated an increased risk of complications and severe neurological deficit. Objective: to evaluate the validity of VWF and ADFAMTS13 as diagnostic markers of cerebral infarction by comparing the two markers’ validity in diagnosis. Methods: this case control study enrolled 38 cerebral infarction patients 20 acute infarction and 18 recurrent infarction. Patients were compared with 65 age and sex with control patients. We performed the VWF assay using the minividas immunofluorescence technique and the ADAMTS13 assay using the ELISA technique. Results: VWF level of acute infarction patients (280.97 ± 109.83 IU/dl) while its level in recurrent infarction (264.93 ± 172.8 IU/dl) were highly significantly increased compared to control (75.8 ± 16.24 IU/dl). ADAMTS13 level of acute infarction patients was (506.11 ± 225.24 ng/dl) and (1386.03 ± 667.64 ng/dl) in recurrent infarction patients with highly significant differences between the acute and control group and non-significant different between recurrent and control. ADAMTS13 is an excellent diagnostic test in acute cerebral infarction but a weak diagnostic test in recurrent cerebral infarction but it is a good diagnostic test in differentiation between acute and recurrent cerebral infarction patients. VWF is an excellent diagnostic test in both acute and recurrent cases. In acute infarction, VWF is positively correlated with kidney function while ADAMTS13 level did not correlate with different laboratory parameters in recurrent infarction. A positive correlation is present between ADAMTS13 and PT & PTT concentration. No correlation exists between VWF & ADAMTS13 in the 3 groups. Conclusion: ADAMTS13 is closely related to the occurrence, development and progression of acute cerebral infarction, protecting the brain from ischaemic reperfusion injury. It is an excellent diagnostic test in acute cerebral infarction but a weak diagnostic test in recurrent cerebral infarction while VWF is an excellent diagnostic test in acute & recurrent cerebral infarction. ADAMTS13 is expected to become a new therapeutic agent in acute cerebral infarction patients.