Symptomatic intraparenchymal hemorrhage (sICH) and major bleeding can be fatal complications of intravenous thrombolysis (IVT) for acute ischemic stroke. We investigated the impact of early fibrinogen depletion after IVT on major bleeding events.
This multicenter observational study enrolled consecutive patients receiving IVT for acute ischemic stroke at 6 Italian centers, undergoing fibrinogen concentration assessment at baseline, 2 hours and 6 hours after IVT. Fibrinogen depletion was defined as a reduction below 200 mg/dl after 2 hours from IVT, or as a reduction below 50% of baseline fibrinogen levels after 2 hours from IVT. Main outcomes were (i) sICH according to National Institute of Neurological Disorders and Stroke criteria, and (ii) major bleeding.
Overall, 1678 patients were included. sICH (n=116) and major bleeding (n=297) were associated with lower prevalence of good functional recovery (p<0.001). Despite similar fibrinogen levels at admission, fibrinogen depletion after 2 hours from IVT was more common in people with sICH and major bleeding. In the backward stepwise multivariable logistic regression model, fibrinogen depletion remained a significant predictor of sICH (OR 1.55, 95%CI 1.04-2.32) and major bleeding (OR 1.36, 95%CI 1.03-1.8).
Fibrinogen depletion significantly increases the risk of sICH and major bleeding after IVT for acute ischemic stroke. Routine assessment of fibrinogen might be considered to stratify the risk of ICH.