title: Fibrinogen decrease after intravenous thrombolysis in ischemic stroke patients is a risk factor for intracerebral hemorrhage.
abstract: BACKGROUND
  Intravenous thrombolysis is an effective treatment in acute stroke patients, but it increases the risk of intracerebral hemorrhages. Our aim is to establish if fibrinogen depletion increases the risk of intracerebral hemorrhage after intravenous thrombolysis for acute ischemic stroke.
  
  
  METHODS
  In 104 ischemic stroke patients, treated with intravenous thrombolysis, we assessed the rate of intracerebral hemorrhages documented by computed tomographic scan at 24 hours and within 7 days post-treatment. Fibrinogen levels were determined at 2 hours after therapy: patients were classified as belonging to "low fibrinogen group" if levels decreased to less than 2 g/L and/or by 25% or more. Fibrinogen levels and other known hemorrhagic risk factors were studied using univariate and multivariate analyses.
  
  
  RESULTS
  During the first 7 days, an intracerebral hemorrhage was detected in 24 patients (23.1%), and only 6 of these (5.8%) experienced symptomatic bleeding; 41 patients were included in the low fibrinogen group. Among the 24 hemorrhages, 18 occurred in the low fibrinogen group and 6 in the "normal fibrinogen group": the bleeding rate in the low fibrinogen group was significantly higher (43.9%) than that in the normal fibrinogen group (9.5%; odds ratio [OR] 7.43, P < .001). Univariate and multivariate analyses revealed that only clinical severity (OR 1.15, P < .001) and hypofibrinogenemia (OR 7.47, P < .001) were significantly associated with brain bleeding at 7 days and at 24 hours (P = .008).
  
  
  CONCLUSIONS
  An early fibrinogen reduction seems to increase the risk of intracerebral hemorrhage after rtPA treatment in ischemic stroke. Fibrinogen assessment could be a rapid, inexpensive, and widely available tool to help the identification of patients at higher risk of bleeding.
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Vandelli
authors.affiliation: Section of Haematology, Department of Oncology and Haematology, Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marietta
authors.affiliation: Environmental Protection Agency, ARPA Emilia Romagna District of Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Mariaelena
authors.initials: M
authors.lastname: Gambini
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Cavazzuti
authors.affiliation: Clinical Pathology-Toxicology, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Trenti
authors.affiliation: Clinical Pathology-Toxicology, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cenci
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Casoni
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bigliardi
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pentore
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nichelli
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, Modena, Italy. Electronic address: andrea.zini@me.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology*; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator
keywords: Fibrinogen; acute stroke; intracerebral hemorrhage; risk factors; rtPA; thrombolysis