Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 2, February, p. 219–222

doi: 10.17219/acem/84936

Publication type: original article

Language: English

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Fibrinogen concentrate replacement in ischemic stroke patients after recombinant tissue plasminogen activator treatment

Laura Vandelli1,A,B,C,D,E, Marco Marietta2,A,E, Tommaso Trenti3,B,E, Manuela Varani3,B,E, Guido Bigliardi1,B,E, Francesca Rosafio1,B,E, Maria Luisa Dell'acqua1,B,E, Livio Picchetto1,B,E, Paolo Nichelli1,B,E, Andrea Zini1,A,C,D,E,F

1 Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Modena, Italy

2 Department of Oncology and Hematology, Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy

3 Clinical Pathology – Toxicology Department, Nuovo Ospedale Civile S. Agostino-Estense, Azienda Unita' Sanitaria Locale di Modena, Italy

Abstract

Background. Post-thrombotic intracerebral hemorrhage (ICH) is experienced by 6–8% of stroke patients and is associated with multiple factors, including acquired coagulopathy induced by the thrombolytic drug.
Objectives. The objective of this study was to assess the outcome of the intravenous (IV) administration of fibrinogen concentrate in a series of acute stroke patients who developed iatrogenic fibrinogen critical depletion after IV thrombolysis.
Material and Methods. Of the 39 ischemic stroke patients treated with IV thrombolysis with a severe hypofibrinogenemia requiring infusion with IV fibrinogen concentrate, 30 patients were treated with 2 g of IV recombinant tissue plasminogen activator (rt-PA), followed by further doses until the fibrinogen level reached 200 mg/dL in hemorrhagic patients or 100 mg/dL in non-hemorrhagic patients, and 9 were treated with IV rt-PA followed by endovascular thrombectomy.
Results. Preand post-thrombolysis National Institutes of Health Stroke Scale (NIHSS) scores were statistically different for the Cochran-Mantel-Haenszel test overall (p = 0.0002), at 24-hour evaluation (p = 0.0455) and at 7-day assessment (p = 0.0006). Within the first 7 days post-thrombolysis, the brain computed tomography (CT) scans showed that 20/39 (51.28%) patients had ICH. Of the whole sample, 25.6% of the ICH patients had symptomatic intracerebral hemorrhage (SICH), according to National Institute of Neurological Disorders and Stroke (NINDS) classification. After rt-PA treatment, the median pre-thrombolysis fibrinogenemia of 332 mg/dL significantly dropped to 133 mg/dL (p < 0.0001). After the fibrinogen concentrate infusion, the median level of fibrinogenemia rose to 160 mg/dL, which was significantly higher than the median postthrombolysis levels (p < 0.0001). Recanalization was observed in 25/28 patients (89.29%): complete in 18 and partial in 7 patients. After fibrinogen IV infusion, no thrombotic complications were seen in 37 out of 39 patients (94.77%); 2/39 (0.05%) patients experienced a pulmonary embolism, 1 of them a segmental one.
Conclusion. This study showed the clinical safety of administering IV fibrinogen concentrate in order to increase plasma fibrinogen levels in a series of acute stroke patients with iatrogenic fibrinogen depletion after IV thrombolysis.

Key words

ischemic stroke, fibrinogen concentrate replacement, recombinant tissue plasminogen activator

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