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205 Relationship between thrombin generation and micro-embolic signals in moderate-severe asymptomatic and symptomatic carotid stenosis patients

Background Data are limited on thrombin generation biomarker profiles in carotid stenosis patients with or without cerebral micro-embolic signals (MES). Aims and Methods In this prospective, multi-centre, observational study, plasma thrombin generation parameters were compared in patients with ≥50-99% asymptomatic(N=34) vs. symptomatic carotid stenosis in the early (≤4 weeks; N=39) and late phases (≥3 months; N=31) after TIA/ischaemic stroke. Nested longitudinal follow-up was performed in symptomatic patients. Transcranial Doppler ultrasound classified patients as MES+ve or MES-ve. Results There were no significant differences in thrombin generation parameters between early or late symptomatic vs. asymptomatic patients (P≥0.17). In symptomatic patients with matched data at each timepoint, peak thrombin production (365.1 vs. 327.2nM; P=0.003) and endogenous thrombin potential (2242.6 vs. 2078.4 nM*min; P=0.048) decreased between the early and late phases overall. The fall in peak thrombin during follow-up was significant in symptomatic subgroups who underwent revascularisation (N=26; P=0.007) and who were MES-ve (N=14; P=0.029), but not in those on optimal medical therapy alone (N=5; P=0.19). Discussion Thrombin generation decreases over time and following revascularisation in TIA/stroke patients with moderate-severe symptomatic carotid stenosis, including those who are MES-ve. These data improve our understanding of haemostatic/thrombotic biomarker profiles in patients with carotid stenosis.