Fibrinogen and viscosity as risk factors for subsequent cardiovascular events in stroke survivors.
OBJECTIVE
To investigate whether abnormalities in blood viscosity predict a poor prognosis for subsequent cardiovascular events in stroke survivors.


METHODS
Nested case-control study among a cohort of survivors of a first stroke, followed for an average of 2 years. Patients with a second stroke, myocardial infarction, or cardiovascular death were matched with patients who did not have such events (control patients).


METHODS
Buchberg-Klinik, Bad Tölz, Germany, a specialized center for stroke rehabilitation.


METHODS
A total of 625 consecutive patients. Twenty-one patients (3.5%) were lost to follow-up. Sixty pairs were matched.


METHODS
Native and hematocrit-standardized blood viscosity at three shear rates, hematocrit, plasma viscosity, fibrinogen, erythrocyte sedimentation rate, total leukocyte count, and the matching variables.


RESULTS
Eighty-five patients had a second stroke, myocardial infarction, or died due to a cardiovascular event. Patients with re-events had higher blood viscosity and fibrinogen levels than the control patients. In the 60 matched pairs, the mean of the paired differences between patients with re-events and control patients was 5.03 mPa.s (95% CI, 1.262 to 8.941; P = 0.01) for native blood viscosity at shear rate 0.7 s-1, for plasma viscosity, 0.044 mPa.s (CI, 0.006 to 0.083; P greater than 0.02), and for fibrinogen, 0.056 g/L (CI, 0.010 to 0.101; P greater than 0.02). Odds ratios were significantly increased only for plasma viscosity (odds ratio, 2.86; CI, 1.06 to 8.43) and fibrinogen (odds ratio, 3.67; CI, 1.31 to 11.69).


CONCLUSIONS
Hyperfibrinogenemia is an independent risk factor for cardiovascular events in stroke survivors. Intervention trials with fibrinogen lowering measures may be warranted.
Resch
K L
KL
University of Vienna, Austria.
Ernst
E
E
Matrai
A
A
Paulsen
H F
HF
D000368:Aged; D001809:Blood Viscosity; D002545:Brain Ischemia / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000150:complications; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors
D005340:Fibrinogen