Dynamic Changes in Fibrinogen and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Abstract

This study aimed to investigate the association between dynamic changes in fibrinogen and the prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). We measured fibrinogen levels at admission and 24 h after IVT in 364 consecutively recruited AIS patients. The primary outcome was the composite measure of death or major disability (modified Rankin Scale score 3–6) at 3 months. During the 3-month follow-up, 127 (34.89%) patients experienced death or major disability. After multivariate adjustment, a ≥ 2.5% increase in fibrinogen was associated with an increased risk of the primary outcome (odds ratio [OR], 2.26; 95% confidence interval [CI] 1.08–4.75; p trend = 0.030) when 2 extreme tertiles were compared. Each 1% increase in fibrinogen after IVT was associated with a 1% increase in the risk of the primary outcome (OR 1.01, 95% CI 1.00–1.03). Multivariable-adjusted spline regression revealed a linear dose-response relationship between fibrinogen changes after IVT and the primary outcome (p for linearity = 0.032). The addition of fibrinogen changes to conventional risk factors improved the re-classification (but not discrimination) of the primary outcome (net reclassification index 27.6%, p = 0.011). These findings indicated that an increase in fibrinogen after IVT was associated with an increased risk of death or major disability in AIS patients, suggesting that monitoring the dynamic profile of fibrinogen levels may help neurologists improve stroke outcomes in clinical settings.

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Acknowledgments

The authors wish to thank the clinical staff for their support in providing data and for contributing to this study.

Funding

This work was supported by grants from the National Natural Science Foundation of China [grant number 81471195], the Suzhou Clinical Research Center of Neurological Disease [grant number szzx201503], and the Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project Funding [grant number XKQ2015002].

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Correspondence to Yongjun Cao.

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Shi, J., Shi, R., Qin, W. et al. Dynamic Changes in Fibrinogen and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Neurotox Res (2020). https://doi.org/10.1007/s12640-020-00241-w

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Keywords

  • Acute ischemic stroke
  • Intravenous thrombolysis
  • Fibrinogen
  • Prognosis