Effective therapy for stroke totally depends on prompt diagnosis, whereas the existing practices mainly rely on neuroimaging, which may result in therapeutic delays, particularly in pre-hospital or resource-constrained settings. The development of blood-based biomarkers that can help to differentiate between ischemic and hemorrhagic stroke within a couple of minutes is a new innovation that has been gaining momentum.
Glial fibrillary acidic protein (GFAP) is one of these biomarkers that has turned out to be an excellent predictor of hemorrhagic stroke. Elevated levels of GFAP are warning signs of hemorrhagic pathology since GFAP is released directly into the bloodstream immediately after astrocyte destruction, which is observed in early intracerebral hemorrhage.
On the contrary, indicators that suggest neuronal damage rather than astrocyte rupture are more often linked to ischemic stroke. Regardless of slower early kinetics than GFAP, neurofilament light chain (NfL), along with other indicators of axonal damage, tends to spike after ischemic injury and correlates with infarct size and stroke severity. Therefore, in an actual clinical setting, lower levels of GFAP in conjunction with higher neuronal damage markers may support an ischemic stroke diagnosis.
Based on early clinical studies, GFAP-based assays, either by themselves or in collaboration with other biomarkers, may facilitate much quicker thrombolysis decision and the immediate exclusion of bleeding, perhaps even before imaging is available. Such tests have the capability to substantially reduce door-to-needle time and enhance prompt stroke therapy in rural hospitals and ambulances, provided they are validated on a large scale.
If some blood biomarkers can accurately differentiate between ischemic and hemorrhagic stroke in a matter of minutes, should pre-hospital stroke triage move toward biomarker-guided decision-making in addition to imaging?
MBH/PS