Hyperfibrinogenemia and functional outcome from acute ischemic stroke

Gregory J. Del Zoppo, David E. Levy, Warren W. Wasiewski, Arthur M. Pancioli, Andrew M. Demchuk, James Trammel, Bart M Demaerschalk, Markku Kaste, Gregory W. Albers, Eric B. Ringelstein

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background and Purpose-: 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. Conclusion-: 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.

Original languageEnglish (US)
Pages (from-to)1687-1691
Number of pages5
JournalStroke
Volume40
Issue number5
DOIs
StatePublished - May 1 2009

Fingerprint

Ancrod
Stroke
Fibrinogen
Therapeutics
Intravenous Infusions
Epidemiologic Studies
Logistic Models
Placebos
Regression Analysis
Mortality
Incidence

Keywords

  • Acute ischemic stroke
  • Defibrinogenation
  • Fibrinogen
  • Functional outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Del Zoppo, G. J., Levy, D. E., Wasiewski, W. W., Pancioli, A. M., Demchuk, A. M., Trammel, J., ... Ringelstein, E. B. (2009). Hyperfibrinogenemia and functional outcome from acute ischemic stroke. Stroke, 40(5), 1687-1691. https://doi.org/10.1161/STROKEAHA.108.527804

Hyperfibrinogenemia and functional outcome from acute ischemic stroke. / Del Zoppo, Gregory J.; Levy, David E.; Wasiewski, Warren W.; Pancioli, Arthur M.; Demchuk, Andrew M.; Trammel, James; Demaerschalk, Bart M; Kaste, Markku; Albers, Gregory W.; Ringelstein, Eric B.

In: Stroke, Vol. 40, No. 5, 01.05.2009, p. 1687-1691.

Research output: Contribution to journalArticle

Del Zoppo, GJ, Levy, DE, Wasiewski, WW, Pancioli, AM, Demchuk, AM, Trammel, J, Demaerschalk, BM, Kaste, M, Albers, GW & Ringelstein, EB 2009, 'Hyperfibrinogenemia and functional outcome from acute ischemic stroke', Stroke, vol. 40, no. 5, pp. 1687-1691. https://doi.org/10.1161/STROKEAHA.108.527804
Del Zoppo GJ, Levy DE, Wasiewski WW, Pancioli AM, Demchuk AM, Trammel J et al. Hyperfibrinogenemia and functional outcome from acute ischemic stroke. Stroke. 2009 May 1;40(5):1687-1691. https://doi.org/10.1161/STROKEAHA.108.527804
Del Zoppo, Gregory J. ; Levy, David E. ; Wasiewski, Warren W. ; Pancioli, Arthur M. ; Demchuk, Andrew M. ; Trammel, James ; Demaerschalk, Bart M ; Kaste, Markku ; Albers, Gregory W. ; Ringelstein, Eric B. / Hyperfibrinogenemia and functional outcome from acute ischemic stroke. In: Stroke. 2009 ; Vol. 40, No. 5. pp. 1687-1691.
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abstract = "Background and Purpose-: 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. Conclusion-: 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.",
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AU - Trammel, James

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AB - Background and Purpose-: 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. Conclusion-: 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.

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