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


CONCLUSIONS
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.
['Vandelli|Laura|L|', 'Marietta|Marco|M|', 'Trenti|Tommaso|T|', 'Varani|Manuela|M|', 'Bigliardi|Guido|G|', 'Rosafio|Francesca|F|', "Dell'acqua|Maria Luisa|ML|", 'Picchetto|Livio|L|', 'Nichelli|Paolo|P|', 'Zini|Andrea|A|']
D061605:Administration, Intravenous D002545:Brain Ischemia D005340:Fibrinogen D005343:Fibrinolytic Agents D006801:Humans D020521:Stroke D015912:Thrombolytic Therapy D013997:Time Factors D010959:Tissue Plasminogen Activator D016896:Treatment Outcome
fibrinogen concentrate replacement ischemic stroke recombinant tissue plasminogen activator