The dynamic of concentration of von Willebrand factor concentration in peracute and acute periods of cardioembolic stroke during heparin therapy

Tran M.D.; Yasamanova A.N.; Shurdumova M.Kh.; Petrova E.A.; Koltsova E.A.; Avakyan G.G.

doi:https://doi.org/10.17116/jnevro202512503269

Tran M.D.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-3146-0822

Yasamanova A.N.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-4618-922X

Shurdumova M.Kh.

Pirogov Russian National Research Medical University (Pirogov University);
City Clinical Hospital No. 31

ORCID: 0000-0003-4639-7237

Petrova E.A.

Pirogov Russian National Research Medical University (Pirogov University)

ORCID: 0000-0002-9679-7899

Koltsova E.A.

Pirogov Russian National Research Medical University (Pirogov University)

ORCID: 0000-0001-6459-2656

Avakyan G.G.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-8985-8227

The dynamic of concentration of von Willebrand factor concentration in peracute and acute periods of cardioembolic stroke during heparin therapy

Authors:

Tran M.D., Yasamanova A.N., Shurdumova M.Kh., Petrova E.A., Koltsova E.A., Avakyan G.G.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2025;125(3‑2): 69‑76

DOI: 10.17116/jnevro202512503269

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To cite this article:

Tran MD, Yasamanova AN, Shurdumova MKh, Petrova EA, Koltsova EA, Avakyan GG. The dynamic of concentration of von Willebrand factor concentration in peracute and acute periods of cardioembolic stroke during heparin therapy. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;125(3‑2):69‑76. (In Russ.)
https://doi.org/10.17116/jnevro202512503269

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски (S.S. Korsakov Journal of Neurology and Psychiatry (special issues))

Использование инфографики авторами научных работ

OBJECTIVE

To study the prognostic value of von Willebrand factor (vWF) in peracute and acute periods of cardioembolic stroke (CES) in patients receiving unfractionated (UFH) and low molecular weight heparin (LMWH).

MATERIAL AND METHODS

Thirty patients with CES receiving UFH/LMWH and acetylsalicylic acid were examined. The comparison group included 15 patients with non-cardioembolic stroke without heparin therapy. On Days 2—3 and 7—10 from the disease onset, patients were evaluated using the NIHSS and HAS-BLED scales; also, brain CT, Doppler ultrasound, echocardiography, complete blood count and blood chemistry, vWF measurement, and induced platelet aggregation test with ristocetin, arachidonic acid, and collagen were performed.

RESULTS

During LMWH therapy in the peracute period, increased platelet aggregation with ristocetin (p=0.038) and vWF levels (p=0.017) were found versus the comparison group. A correlation between vWF level and platelet aggregation with collagen was identified (p=0.010, r=0.461). No inhibition of platelet function with ristocetin was observed during the entire period of therapy with both LMWH and UFH. During LMWH treatment, increased platelet activity with ristocetin was observed in the acute period, compared with patients receiving UFH (p=0.007). There were no significant differences in the change in the vWF levels in patients with and without hematuria. There was a correlation between the HAS-BLED score and hematuria in the semiquantitative analysis of erythrocytes in urine (p=0.041, r=0.375), as well as a correlation between the vWF levels and the ASPECT score (p=0.001, r=–0.576).

CONCLUSION

The concomitant use of heparin with antiplatelet agents, particularly with aspirin in CES, enhances its anticoagulant activity and inhibits platelets in the test with arachidonic acid. Continued high ristocetin- and collagen-induced platelet aggregation supports the use of vasoprotective agents activating metabolic processes in the walls of blood vessels to correct persistent endothelial dysfunction.

Keywords:

cardioembolic stroke

unfractionated heparin

low molecular weight heparin

platelet aggregation

ristocetin

von Willebrand factor

Authors:

Tran M.D.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-3146-0822

Yasamanova A.N.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-4618-922X

Shurdumova M.Kh.

Pirogov Russian National Research Medical University (Pirogov University);
City Clinical Hospital No. 31

ORCID: 0000-0003-4639-7237

Petrova E.A.

Pirogov Russian National Research Medical University (Pirogov University)

ORCID: 0000-0002-9679-7899

Koltsova E.A.

Pirogov Russian National Research Medical University (Pirogov University)

ORCID: 0000-0001-6459-2656

Avakyan G.G.

Pirogov Russian National Research Medical University

ORCID: 0000-0002-8985-8227

Received:

28.12.2024

Accepted:

09.01.2025

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References:

Shamalov NA, Stakhovskaya LV, Klochihina OA, et al. An analysis of the dynamics of the main types of stroke and pathogenetic variants of ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(3-2):5-10. (In Russ.). https://doi.org/10.17116/jnevro20191190325
Podzolkov VI, Tarzimanova AI, Mokhammadi LN, et al. The altered endothelial function in patients with arterial hypertension and different forms of atrial fibrillation. Clinical Medicine Russian Journal = Klinicheskaya meditsina. 2014;92(3):42-46. (In Russ.).
Boneu B, Abbal M, Plante J, et al. Letter: Factor-VIII complex and endothelial damage. Lancet. 1975;1(7922):1430. https://doi.org/10.1016/s0140-6736(75)92650-1
Staessens S, Denorme F, Francois O, et al. Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance. Haematologica. 2020;105(2):498-507. https://doi.org/10.3324/haematol.2019.219881
Sonneveld MA, de Maat MP, Leebeek FW. Von Willebrand factor and ADAMTS13 in arterial thrombosis: a systematic review and meta-analysis. Blood Rev. 2014;28(4):167-178. https://doi.org/10.1016/j.blre.2014.04.003
McCabe DJ, Murphy SJ, Starke R, et al. Relationship between ADAMTS13 activity, von Willebrand factor antigen levels and platelet function in the early and late phases after TIA or ischaemic stroke. J Neurol Sci. 2015;348(1-2):35-40. https://doi.org/10.1016/j.jns.2014.10.035
Kovacevic KD, Mayer FJ, Jilma B, et al. Von Willebrand factor antigen levels predict major adverse cardiovascular events in patients with carotid stenosis of the ICARAS study. Atherosclerosis. 2019;290:31-36. https://doi.org/10.1016/j.atherosclerosis.2019.09.003
Gusev EI, Martynov MIu, Koltsov IA, et al. Prognostic value of endothelial dysfunction and von Willebrand factor in acute and chronic hemispheric intracerebral hemorrhage. S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(8-2):46-52. (In Russ.). https://doi.org/10.17116/jnevro201911908246
Lutai MI, Golikova IP, Deyak SI, et al. Relationship of von Willebrand factor with vasomotor function of endothelium in patients with different severity levels of venous artery atherosclerosis. Ukrainian Cardiologic Journal. 2003;6:1-6. (In Russ.).
De Ceunynck K, De Meyer SF, Vanhoorelbeke K. Unwinding the von Willebrand factor strings puzzle. Blood. 2013;121(2):270-277. https://doi.org/10.1182/blood-2012-07-442285
Lenting PJ, Christophe OD, Denis CV. von Willebrand factor biosynthesis, secretion, and clearance: connecting the far ends. Blood. 2015;125(13):2019-2028. https://doi.org/10.1182/blood-2014-06-528406
Grigoreva KN, Bitsadze VO, Khizroeva JKh, et al. Prognostic value of von Willebrand factor in clinical practice. Obstetrics, Gynecology and Reproduction. 2022;16(5):588-599. (In Russ.). https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.363
Ischemic stroke and transient ischemic attack in adults. Clinical recommendations. M. 2021;260. (In Russ.).
Dankovtseva EN, Arkhipov SL, Zateishchikov DA. Warfarin use in patients with cardioembolic stroke. Rational pharmacotherapy in cardiology. 2012;8(4):581-586. (In Russ.).
Rubanenko AO, Rubanenko OA. The role of estimation of plasma von Willebrand factor concentration in stroke risk stratiﬁcation in patients with atrial ﬁbrillation. Russian journal of hematology and transfusiology. 2022;67(3):419-425. (In Russ.). https://doi.org/10.35754/0234-5730-2022-67-3-419-425
Ostroumova OD, Butorov VN. Application of nadroparin in clinical practice. Therapy. 2022;8(6):133-139. (In Russ.). https://doi.org/10.18565/therapy.2022.6.133-139
Hirsh J, Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001;119(1 Suppl):64S-94S. https://doi.org/10.1378/chest.119.1_suppl.64s
Poletti LF, Bird KE, Marques D, et al. Structural aspects of heparin responsible for interactions with von Willebrand factor. Arterioscler Thromb Vasc Biol. 1997 May;17(5):925-931. https://doi.org/10.1161/01.atv.17.5.925
Tatarskiy BA, Kazennova NV, Andreev DA. Anticoagulant-related nephropathy. Cardiology: news, opinions, training. 2018;6(4):54-58. (In Russ.). https://doi.org/10.24411/2309-1908-2018-14008