Thrombus formation, endogenous fibrinolysis and atrial fibrillation states in patients with ischaemic stroke: An assessment using global thrombosis test profiles

Chen, Y, Gue, Y, Elsheikh, S, Ditchfield, C, Koolaji, S, Hill, AM, McDowell, G ORCID: 0000-0002-2880-5236, Gorog, DA and Lip, GYH ORCID: 0000-0002-7566-1626 (2026) Thrombus formation, endogenous fibrinolysis and atrial fibrillation states in patients with ischaemic stroke: An assessment using global thrombosis test profiles. Thrombosis Research, 264. ISSN 0049-3848

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Abstract

Background: Atrial fibrillation (AF) is often first detected during or after ischaemic stroke (IS), yet many cases remain undetected. We evaluated whether thrombotic and fibrinolytic profiles vary with AF status in IS and whether these markers may help identify AF. Methods: We conducted a prospective observational study of adults with confirmed IS, with blood sampling during index admission after withholding pre-admission anticoagulant therapy where applicable. Patients were classified as AF or non-AF, with AF subtyped as known AF (KAF, N = 20), AF detected concurrently with stroke (AFDCS, N = 10), or detected after stroke (AFDNCS, N = 6). Thrombotic status was assessed using Global Thrombosis Test-derived occlusion time (OT) and lysis time (LT). Multivariable linear regression analyses were performed to account for demographic, clinical, and anticoagulant-related factors. An exploratory cohort excluding KAF, AFDCS, and thrombolysis was used to evaluate AFDNCS prediction. Results: 115 patients with IS (mean [SD] age: 68.5 ± 13.5 years; 57.4% male) were included. AF patients were older and had a higher burden of comorbidities, but most laboratory parameters were similar between groups. Despite normal coagulation tests, AF patients had longer OT than non-AF patients (474 ± 214 vs. 373 ± 176 s, P = 0.009), while LT did not differ. OT varied significantly across AF states (P = 0.002), longest in KAF and shortest in AFDNCS, whereas LT did not differ. In multivariable analyses, the association between AF and longer OT was attenuated after accounting for prior anticoagulant exposure. In the exploratory cohort (N = 72) with 5 AFDNCS cases during 6-month follow-up, OT showed discrimination for predicting AFDNCS (AUC = 0.737, 95% CI 0.620–0.834). Conclusions: We identify distinct haemostatic patterns across AF states in patients with IS. Short OT in patients with AFDNCS may identify a cohort at increased ischaemic risk of future events, and requires further study.

Item Type:	Article
Uncontrolled Keywords:	Atrial fibrillation; Ischaemic stroke; Global thrombosis test; Occlusion time; Lysis time; Thrombosis; Fibrinolysis; Humans; Brain Ischemia; Atrial Fibrillation; Thrombosis; Prospective Studies; Fibrinolysis; Aged; Aged, 80 and over; Middle Aged; Female; Male; Ischemic Stroke; Atrial fibrillation; Fibrinolysis; Global thrombosis test; Ischaemic stroke; Lysis time; Occlusion time; Thrombosis; Humans; Atrial Fibrillation; Male; Aged; Fibrinolysis; Ischemic Stroke; Female; Thrombosis; Prospective Studies; Middle Aged; Brain Ischemia; Aged, 80 and over; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; Heart Disease; Hematology; Clinical Research; Brain Disorders; Stroke; Cardiovascular; Cerebrovascular; 4.2 Evaluation of markers and technologies; Cardiovascular; Stroke; 1103 Clinical Sciences; Cardiovascular System & Hematology; 3201 Cardiovascular medicine and haematology; 3202 Clinical sciences
Subjects:	R Medicine > RS Pharmacy and materia medica R Medicine > RT Nursing
Divisions:	Nursing, Public and Allied Health Pharmacy and Biomolecular Sciences
Publisher:	Elsevier
Date of acceptance:	6 July 2026
Date of first compliant Open Access:	10 September 2026
Date Deposited:	10 Sep 2026 09:05
Last Modified:	10 Sep 2026 09:05
DOI or ID number:	10.1016/j.thromres.2026.109772
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29370

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