Hyperfibrinogenemia and functional outcome from acute ischemic stroke.
OBJECTIVE
Epidemiological studies have found strong correlations between elevated plasma fibrinogen levels and both ischemic stroke incidence and stroke mortality. Little is known about the influence of fibrinogen levels on functional stroke outcome.


METHODS
Placebo data from the Stroke Treatment with Ancrod Trial (STAT) and European Stroke Treatment with Ancrod Trial (ESTAT) were analyzed. Fibrinogen levels were determined within 3 hours (STAT) or 6 hours (ESTAT) of stroke onset and at preset intervals throughout 5 days of intravenous infusions. Barthel Index scores at 90 days quantified functional outcomes. The association between initial fibrinogen levels and functional outcomes was evaluated using a multiple logistic regression analysis.


RESULTS
Fibrinogen levels increased gradually over the first 24 hours from a pretreatment median value of 340 mg/dL to a 24-hour median value of 376 mg/dL. In a univariate analysis, the proportion of patients with good functional outcome decreased with increasing quartiles of initial fibrinogen levels in both STAT (36.0% to 26.2%) and ESTAT (53.8% to 24.8%). In a multifactorial analysis, the same trend was observed. Patients with initial fibrinogen levels <450 mg/dL had better outcomes in both studies; the difference (42.0% versus 21.6%) was significant in ESTAT (P=0.0006), even when corrected for age and initial stroke severity.


CONCLUSIONS
The independent association of higher initial fibrinogen levels with poor outcome needs to be verified using a larger acute stroke dataset. Even in the present small populations, the apparent association of these 2 variables suggests that treatments designed to reduce fibrinogen levels could potentially be important in treating acute ischemic stroke.
del Zoppo
Gregory J
GJ
Harborview Medical Center, University of Washington, Seattle, WA 98104, USA. grgdlzop@u.washington.edu
Levy
David E
DE
Wasiewski
Warren W
WW
Pancioli
Arthur M
AM
Demchuk
Andrew M
AM
Trammel
James
J
Demaerschalk
Bart M
BM
Kaste
Markku
M
Albers
Gregory W
GW
Ringelstein
Eric B
EB
D000208:Acute Disease; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications*; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D013534:Survival; D016896:Treatment Outcome
D005340:Fibrinogen