Fibrinogen Level Combined With Platelet Count for Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Abstract

A serious complication of acute ischemic stroke (AIS) after mechanical thrombectomy (MT) is hemorrhagic transformation (HT), which is potentially associated with clinical deterioration. This study examined predictors of HT following MT in AIS patients. Patients with AIS due to large artery occlusion in the anterior circulation, treated with MT and successfully recanalized (modified Thrombolysis in Cerebral Infarction score 2b/3), were studied retrospectively. HT was evaluated by computed tomography (CT) 24 h after MT and was diagnosed and classified into parenchymal hematoma (PH) and hemorrhagic infarction (HI). Multivariate logistic regression models were used to determine the risk factors for HT. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive utility of risk factors for HT. We enrolled 135 patients: 49 in the HT group and 86 in the non-HT group. The two groups differed significantly in baseline fibrinogen levels (p = 0.003) and platelet counts (p = 0.006). Multivariate logistic regression analyses showed that lower fibrinogen levels [odds ratio (OR), 0.41; 95% CI, 0.23–0.72; p = 0.002] and platelet counts (OR, 0.58; 95% CI, 0.33–0.99; p = 0.048) were independently associated with a higher risk of HT. Together, the binary variates fibrinogen and platelets well-predicted HT (area under the curve, 0.703; specificity, 77.9%; sensitivity, 55.1%). The combination of fibrinogen <2.165 g/L and platelets <171.5 × 109/L was the strongest predictor of HT (OR, 23.17; 95% CI, 5.75–126.80; p < 0.0001). Our study suggests that lower baseline fibrinogen levels and platelet counts may be risk factors for HT in AIS patients following MT and reperfusion. Specifically, the combination of fibrinogen level and platelet count may predict the risk of HT after MT in these patients.

Risk Factors and Mechanism of Hemorrhagic Transformation of Acute Ischemic Cerebral Infarction

“…After applying the inclusion & exclusion criteria, eight articles were eligible to be included in the review (see Table 1). Out of the eight articles reviewed, there were two prospective studies [8,9], five retrospective studies [6,[10][11][12][13], and one was both a prospective and retrospective study [14]. The studies were carried out in various countries, such as the China [9,[11][12][13][14], United States [13], United Kingdom [10], Germany [10], Italy [8], and the Republic of Korea [6].…”

“…Out of the eight articles reviewed, there were two prospective studies [8,9], five retrospective studies [6,[10][11][12][13], and one was both a prospective and retrospective study [14]. The studies were carried out in various countries, such as the China [9,[11][12][13][14], United States [13], United Kingdom [10], Germany [10], Italy [8], and the Republic of Korea [6]. The sample size of the participants ranged from 32 patients to 1484 patients.…”

“…It has an inverse relationship to the development of early onset neurological complications [12]. Albumin has anti-inflammatory, anti-oxidative and anti-apoptotic properties and is known to predict endothelial dysfunction which is the major mechanism in hemorrhagic transformation [12].…”

“…It has an inverse relationship to the development of early onset neurological complications [12]. Albumin has anti-inflammatory, anti-oxidative and anti-apoptotic properties and is known to predict endothelial dysfunction which is the major mechanism in hemorrhagic transformation [12]. Albuminuria has been seen to be associated with increased risk of HT in patients with acute ischemic stroke [23], as the presence of albuminuria in the first urine sample gotten from patients with acute ischemic stroke has shown to be an independent risk factor for hemorrhagic transformation of cerebral infarction [23].…”

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

“…Other biochemical factors found to elevate the risk of post-MT HT are: high levels of bilirubin and C-reactive protein (CRP), and low fibrinogen and magnesium (< 0.80 mmol/L). Higher levels of CRP also affected the sICH incidence [46][47][48][49]. An association of some serological markers with post-EVT haemorrhage has also been demonstrated, with, among these, low platelets and white blood cells, along with high neutrophil counts, being risk factors of HT [50].…”