Fibrinogen, blood viscosity, and cerebral ischemia.

Grotta, James C.; Ostrow, Peter T.; Fraifeld, Eduardo M.; Hartman, Deborah; Gary, Howard E.

doi:10.1161/01.str.16.2.192

Cited by 53 publications

(25 citation statements)

References 31 publications

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“…Elevated blood glucose was associated with worse outcome (p , 0.01). [19][20][21] Viscosity, which is dependent upon hematocrit and fibrinogen, has been reported to be inversely associated with cerebral blood flow, 14,22 although not with neurologic outcome. In the subset of subjects in whom fibrinogen level was available (n 5 80), there was no association between calculated viscosity (YSS 15 ) and neurologic outcome.…”

Section: Resultsmentioning

confidence: 99%

Sex differences and hemoglobin levels in relation to stroke outcomes

et al. 2013

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Objective: Women have worse outcomes after stroke compared to men. Since women have lower hemoglobin values, we examined whether hemoglobin levels may associate with worse stroke outcomes in women.Methods: We retrospectively studied 274 patients enrolled in a prospective multicenter study.We explored the relationship of hemoglobin with clinical outcome at 6 months, as measured by the modified Rankin Scale (mRS). Ordinal logistic regression was used to evaluate the independent effect of hemoglobin on clinical outcome, and to explore the influence of sex on that association.Results: Women had a lower mean hemoglobin level (11.7 6 1.8 g/dL) compared to men (13.3 6 1.7 g/dL). Low hemoglobin was associated with worse 6-month mRS outcomes in univariate analysis (p , 0.001). Lower hemoglobin remained independently associated with poor outcome after adjustment for comorbid disease, stroke severity, age, and sex. The inclusion of hemoglobin in the model attenuated the independent effect of sex on outcome.Conclusions: Sex differences in stroke outcome are linked to lower hemoglobin level, which is more prevalent in women. Further examination of this potentially modifiable predictor is warranted. Neurology Women who have a stroke tend to recover less well than men, 1 resulting in greater dependency, institutionalization, 2-4 and poorer quality of life. 5 Several reasons for the disparity have been investigated, including sex differences in clinical presentation and resource use, 2,6 in acute stroke care, 2,7 and biological divergence related to sex steroid hormones. 1 Women with stroke are also older, which may account for some of the observed differences. 8,9 In the context of an expanding elderly population, it is expected that the proportion of women with stroke will further increase, 9 which amplifies the urgency of the problem.Women also have a lower hemoglobin level than men, and previous data have shown that hemoglobin level correlates with worse neuroimaging surrogate outcomes.10 This raises the possibility that a portion of the worse outcome may be mediated by hemoglobin level. The purpose of this study was to assess whether the difference in hemoglobin level between men and women was associated with neurologic outcome, and whether this might account for a proportion of the sex difference in stroke recovery previously observed.METHODS Study population. We retrospectively analyzed the clinical data collected at a single center, as part of a prospective multicenter study evaluating the utility of new CT-based neuroimaging technology to improve prediction of stroke subtype and outcome (Screening Technology and Outcome Project in Stroke [STOPStroke] Study). The STOPStroke Study enrolled consecutive patients who were evaluated by multimodal CT (noncontrast CT, CT angiography, CT perfusion) within 24 hours of symptom onset for symptoms consistent with an acute ischemic stroke. Clinical outcome status was determined using the modified Rankin Scale (mRS)

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Section: Resultsmentioning

confidence: 99%

Sex differences and hemoglobin levels in relation to stroke outcomes

et al. 2013

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“…30 " 32 Hence, a decrease in blood fluidity could be considered a treatable 33 risk factor for ischemic strokes. This hypothesis is supported by an increasing amount of evidence: high normal hemoglobin or hematocrit 34 " 36 and high fibrinogen levels, 37 which are indicators for hyperviscosity, 38 are independent primary risk factors for stroke. Furthermore, the incidence of stroke is increased in the presence of diseases associated with pathologic flow properties of blood.…”

Section: Discussionmentioning

confidence: 94%

Blood rheology in patients with transient ischemic attacks.

Ernst

Mátrai

Marshall

1988

Stroke

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A complete ischemic stroke is associated with a significant hemorheologic disturbance leading to a rise of the viscous component of the peripheral resistance. This abnormality represents a consequence of the acute event. Nonetheless, it could be causally related to ischemia. In an attempt to clarify this question, 26 patients suffering from transient ischemic attacks were compared with controls in terms of blood and plasma viscosity, hematocrit, blood cell filterability, and erythrocyte aggregation. In patients there was a significant impairment of blood fluidity comprising plasma viscosity, blood cell filterability, and erythrocyte aggregation, suggesting that the flow properties of blood are jeopardized even before an acute stroke. Most likely this is due to the underlying arteriosclerotic process. Our results open the way to speculating that hemorheologic mechanisms might predispose to the development of a stroke by decreasing cerebral blood flow. If this hypothesis were true, it would have important therapeutic implications. (Stroke 1988;19:634-636) T here is ample information on the flow properties of blood after an acute ischemic stroke. 1 " 6 These studies unanimously agree that both cellular and plasmatic abnormalities lead to a marked limitation of blood fluidity. Such changes may be looked upon as a consequence of a stroke; however, they could also contribute to the development of ischemia by virtue of their detrimental influence on cerebral blood flow.7 - 8A transient ischemic attack (TLA) with hemodynamicalry relevant stenosis of the internal carotid artery represents a precursor of stroke.*" 11 Little is known about the flow properties of blood in this condition. Our study was aimed at investigating the blood rheology of TLA patients and testing the hypothesis that blood fluidity is impaired not only after, but also before, an ischemic stroke. Subjects and MethodsTwenty-six consecutive outpatients (12 women, 14 men; aged 50 ± 15 years) with a history of TIAs (a minimum of one attack within the last 4 weeks) and ultrasonic evidence of a stenosis of the internal carotid artery of at least 75% were investigated. A control group (n -26) was selected to match the age (47 ± 14 years) and sex distributions (12 women, 14 men) of the patients. The frequency and distribution of cardiovascular risk factors (hypertension, smoking, hyperlipidemias, diabetes, obesity) were comparable in both groups (Table 1). The control group

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“…This could again be part of the acute-phase reaction [13]. Also, high concentrations of fibrinogen may lead to increased blood viscosity and thus reduce cerebral blood flow [29, 32]. …”

Section: Discussionmentioning

confidence: 99%

Progression in Lacunar Stroke Is Related to Elevated Acute Phase Parameters

Audebert¹,

Pellkofer²,

Wimmer³

et al. 2004

Eur Neurol

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Background and Purpose: Despite the small size of lacunar infarcts, progression of neurological deficits is a common problem in this stroke subtype. This investigation studied the frequency and the course of neurological deterioration as well as predictors and possible underlying pathomechanisms of early progression in lacunar stroke. Methods: Fourty-six consecutive patients with acute lacunar stroke were prospectively evaluated by daily clinical neurological examination including the National Institutes of Health Stroke Scale (NIHSS) and follow-up using the Barthel Index after 3 months. Progressive neurological deficit was defined as worsening by ≧1 point in the NIHSS for motor function. Progressive and stable patients were compared regarding clinical profile, inflammatory parameters (leukocytes, body temperature, C-reactive protein), coagulation parameters (fibrinogen, D-dimer, vWF, PTT), and glutamate plasma concentration, as well as blood glucose and blood pressure. Results: Eleven patients (23.9%) showed progression of stroke symptoms, 9 of these within the first 24 h after admission. The score on the NIHSS on admission was similar in patients with progressive stroke and stable patients, but significantly higher in the progressive stroke group on days 2 (p = 0.01), 3 (p = 0.001) and at discharge (p = 0.003). Deterioration was significantly associated with a higher leukocyte count (p = 0.012), higher body temperature (p = 0.031) and a higher fibrinogen concentration (p = 0.046) on admission. Barthel Index at discharge (p = 0.001) and after 90 days (p < 0.001) was significantly worse in the progressive stroke group. Conclusions: Progression in lacunar stroke usually occurs within 24 h and may be related to an acute-phase response. The long-term prognosis of progressive stroke patients is persistently worse compared with patients with nonprogressive stroke.

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Fibrinogen, blood viscosity, and cerebral ischemia.

Cited by 53 publications

References 31 publications

Sex differences and hemoglobin levels in relation to stroke outcomes

Sex differences and hemoglobin levels in relation to stroke outcomes

Blood rheology in patients with transient ischemic attacks.

Progression in Lacunar Stroke Is Related to Elevated Acute Phase Parameters

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