The relationship insulin resistance between coagulation parameters in acute ischemic stroke and its effect on clinic

The insulin resistance is a deficit of a biological response of the exogen and endogen insulin effects and one of the main reason in pathophysiology of type 2 DM. In the epidemiological studies, the relationship between the insulin resistance and stroke risk is shown. There are studies about the resistance of insulin caused the hypercoagulation over von willebrand factor (vWF), fibrinojen, factor VII, factor VIII, factor IX, and factor XII in the literature. The increase of protein C and protein S was notifed as a defence mechanism to this hypercoagulation. Recently, the negative effects of hyperglisemia in the prognosis of acute ischemic stroke was studied, however the existance of insulin resistance in acute period and the effects on clinical practice was not studied. Our purpose in this study which is done as a neurology specialization thesis is to research the possible effects of the insulin resistance on the stroke severity over the coagulation parameters along the duration of the acute ischemic stroke. In this study, 40 cerebral ischemic stroke patients which are not diabetes was observed in the first 24 hours of the attack. The acute stroke severity of the patients was evaluated by using National Institute of Health stroke scale and Canada Stroke Scale. The enrollment was done according to the evaluation of the patients risk factors ( such as sex, age, high blood pressure, cardiac arythmia, and heart failure) and their body mass index was also calculated. To define the insulin resistance of patients, HOMA was calculated by studying of level of the fasting plasma glucose and the level of the fasting insulin. In the study, two groups were aimed one of them has insulin resistance (HOMA > 2.7) and the other one has not, and, both of them have similiar ischemic stroke risk factors. Fibrinogen, Antitrombin III, protein C, protein S, active protein C resistance, and von Willebrand factors were studied concurrently. The differences on the coagulation parameters were checked in the patients with and without insulin resistance. The corelation between HOMA, coagulation parameters and NIHSS and CSS showing stroke severity were evaluated. Our study have shown that the level of protein C and protein S are high in the acute ischemic stroke patients which has insulin resistance. Our findings have showed the modarate statistically significant negative corelations between HOMA and the protein C, but HOMA severity has no effect on stroke severity. Although we could not find the significant relationship between the stroke severity and insulin resistance, the lower protein S level was affecting stroke severity negatively. In conclusions, we found that acute ischemic stroke patients with insulin resistance have tendency to thrombosis. Further studies need to be done explain the effect of insulin resistance on the stroke severity.