Терапевтический архив (Oct 2012)
Fibrinogen concentration in the evaluation of safety and efficiency of thrombolytic therapy in patients with ischemic stroke
Abstract
Aim. To identify and investigate threshold fibrinogen concentrations as predictors of hemorrhagic transformation (HT), fatal outcome (FO), and the efficiency of thrombolytic therapy (TLT) in patients with ischemic stroke (IS). Subjects and methods. One hundred and eighty-one patients with IS were examined; all the patients received TLT. Fibrinogen concentrations were determined by the Clauss method on admission, immediately after TLT, and daily during the first 7 days of observation; the efficacy of thrombolysis was evaluated using the NIH stroke scale every day, the Rankin scale, and the Barthel Index on days 14 and 21.Results. The patients with a fibrinogen concentration of below 330 mg/dl showed the lowest frequency of asymptomatic HT (AHT) as hemorrhagic stroke (HS) type 1 in the absence of clinically worsening HT (CWHT), as well as FO and the highest rate of good functional recovery. Those with a fibrinogen concentration of 330-385 mg/dl most commonly displayed AHT as HS types 1 and 2 equally frequently, as well as the highest frequency of a positive effect according to the criteria for good and/or satisfactory functional recoveries. The fibrinogen concentration range of 385-423 mg/dl compared to the above range was characterized by an increased risk for AHT as HS type 2, for CWHT as equally distributed parenchymal hematoma types 1 and 2, by higher death rates and less chance of functional recovery. The elevated fibrinogen concentration above 423 mg/dl was accompanied by high death rates and CWHT as parenchymal hematoma type 2 and the higher frequency of poor outcome in the evaluation of functional recovery. Conclusion. The revealed three threshold fibrinogen concentrations of 330, 385, and 423 mg/dl allow one to predict HS, FO, and the efficiency of TLT in patients with IS.
