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

Published Date: 07th July 2026

Publication Authors: Ditchfield. C, Hill. AM

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.

Chen, Y, Ditchfield, C; Hill, AM et al. (2026). Thrombus formation, endogenous fibrinolysis and atrial fibrillation states in patients with ischaemic stroke: An assessment using global thrombosis test profiles. Thrombosis Research. 264, Article No 109772. [Online]. Available at: https://doi.org/10.1016/j.thromres.2026.109772 [Accessed 14 July 2026]