Abstract P438: A Reassessment of Hemoglobin and Hematoma Expansion in Intracerebral Hemorrhage

Background: Prior studies identified an increased risk of hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (ICH) and lower admission hemoglobin (Hgb) levels. We aimed to externally validate these findings in a separate cohort of ICH patients. Methods: We performed an observational cohort study on consecutive patients with ICH admitted to a Comprehensive Stroke Center over 2 years, using data from an institutional ICH registry. We excluded patients with secondary, non-spontaneous ICH etiologies, as well as patients who arrived >24 hours from symptom onset. Data on HE (defined as an increase of >33% or >6 mL) and 3-month outcomes were prospectively collected, while admission laboratory values were retrospectively abstracted. We compared admission Hgb, INR, and platelet count (Plt) between patients with and without HE, then determined associations between Hgb, HE, and unfavorable 3-month outcomes (modified Rankin Scale 4-6) after adjusting for established ICH predictors, any anticoagulant use, and laboratory markers of coagulopathy with multivariable logistic regression analysis. Results: Of 375 patients, mean age was 73.6 [SD 13.5], 50% (n=187) were male, 85% (n=317) were white, and 19% (n=71) had HE. Admission Hgb values were similar in patients with and without HE (mean [SD] 13.1 [1.8] g/dl vs. 13.1 [1.9] g/dl, p=0.98), as were INR values (median [IQR] 1.1 [1-1.3] vs. 1.1 [1.0-1.2], p=0.15), although patients with HE had modestly lower Plt (median [IQR] 181 [155-230] x 10 9 /l vs. 207 [170-253] x 10 9 /l, p=0.02). In our multivariable models, Hgb was not associated with HE (OR 0.97, 95% CI 0.83-1.12), but odds of unfavorable 3-month outcome increased with lower Hgb levels (OR 0.81 per 1 g/dL Hgb, 95% CI 0.68-0.96). Conclusion: Our study did not confirm prior associations between Hgb and HE, suggesting that if Hgb is implicated in HE, its effects are likely modest. However, Hgb may mediate outcomes in ICH patients via alternative mechanisms.

Download Full-text

Comparison of Clevidipine and Nicardipine for Acute Blood Pressure Reduction in Patients With Stroke

Journal of Intensive Care Medicine ◽

10.1177/0885066617724340 ◽

2017 ◽

Vol 34 (11-12) ◽

pp. 990-995 ◽

Cited By ~ 3

Author(s):

Teresa A. Allison ◽

Stephanie Bowman ◽

Brian Gulbis ◽

Heather Hartman ◽

Sara Schepcoff ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Reduction ◽

Group Versus ◽

Pressure Control ◽

Care Needs ◽

Observational Cohort ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Time Standard ◽

Mean Time

Objective: The aim of this study was to determine whether clevidipine (CLEV) achieved faster blood pressure control compared to nicardipine (NIC) in patients presenting with either an acute ischemic stroke (AIS) or a spontaneous intracerebral hemorrhage (ICH). Methods: This was a retrospective, observational, cohort study conducted in patients with AIS or ICH admitted to the emergency department of a Comprehensive Stroke Center from November 2011 to June 2013 who received CLEV or NIC continuous infusion for acute blood pressure management. Results: The study included 210 patients: 70 in the CLEV group and 140 in the NIC group. There was no difference in mean time (standard deviation [SD]) from initiation of the infusion to goal systolic blood pressure (SBP), CLEV: 50 (83) minutes versus NIC: 74 (103) minutes, P = .101. Comparison of the 2 agents within diagnosis showed no difference. Hypotension developed in 5 (7.1%) CLEV patients versus 14 (10%) NIC patients ( P = .003). There was no difference in the percentage change at 2 hours; CLEV: −20% (16%) versus NIC: −16% (16%), P = .058. Mean (SD) time to alteplase administration from admission was 56 (22) minutes in the CLEV group versus 59 (25) minutes in the NIC group ( P = .684). Conclusions: There was no difference in the mean time from initiation of the infusion to the SBP goal between agents or in the secondary outcomes. Due to the lack of differences observed, each agent should be considered based on the patient care needs of the institution.

Download Full-text

Preoperative Thrombocytopenia and Postoperative Outcomes after Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182a4441f ◽

2014 ◽

Vol 120 (1) ◽

pp. 62-75 ◽

Cited By ~ 36

Author(s):

Laurent G. Glance ◽

Neil Blumberg ◽

Michael P. Eaton ◽

Stewart J. Lustik ◽

Turner M. Osler ◽

...

Keyword(s):

Platelet Count ◽

Blood Transfusion ◽

Noncardiac Surgery ◽

Multivariable Logistic Regression Analysis ◽

Severe Thrombocytopenia ◽

Normal Platelet ◽

Clinical Indications ◽

Increased Risk ◽

Coagulation Testing ◽

Using Data

Abstract Background: Most studies examining the prognostic value of preoperative coagulation testing are too small to examine the predictive value of routine preoperative coagulation testing in patients having noncardiac surgery. Methods: Using data from the American College of Surgeons National Surgical Quality Improvement database, the authors performed a retrospective observational study on 316,644 patients having noncardiac surgery who did not have clinical indications for preoperative coagulation testing. The authors used multivariable logistic regression analysis to explore the association between platelet count abnormalities and red cell transfusion, mortality, and major complications. Results: Thrombocytopenia or thrombocytosis occurred in 1 in 14 patients without clinical indications for preoperative platelet testing. Patients with mild thrombocytopenia (101,000–150,000 µl−1), moderate-to-severe thrombocytopenia (<100,000 µl−1), and thrombocytosis (≥450,000 µl−1) were significantly more likely to be transfused (7.3%, 11.8%, 8.9%, 3.1%) and had significantly higher 30-day mortality rates (1.5%, 2.6%, 0.9%, 0.5%) compared with patients with a normal platelet count. In the multivariable analyses, mild thrombocytopenia (adjusted odds ratio [AOR], 1.28; 95% CI, 1.18–1.39) and moderate-to-severe thrombocytopenia (AOR, 1.76; 95% CI, 1.49–2.08), and thrombocytosis (AOR, 1.44; 95% CI, 1.30–1.60) were associated with increased risk of blood transfusion. Mild thrombocytopenia (AOR, 1.31; 95% CI, 1.11–1.56) and moderate-to-severe thrombocytopenia (AOR, 1.93; 95% CI, 1.43–2.61) were also associated with increased risk of 30-day mortality, whereas thrombocytosis was not (AOR, 0.94; 95% CI, 0.72–1.22). Conclusion: Platelet count abnormalities found in the course of routine preoperative screening are associated with a higher risk of blood transfusion and death.

Download Full-text

Liver fibrosis indices associated with substantial hematoma expansion in Chinese patients with primary intracerebral hemorrhage

BMC Neurology ◽

10.1186/s12883-021-02494-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huan Wang ◽

Jiongxing Wu ◽

Xue Yang ◽

Junfeng Liu ◽

Wendan Tao ◽

...

Keyword(s):

Logistic Regression ◽

Liver Fibrosis ◽

Intracerebral Hemorrhage ◽

Chinese Population ◽

Binary Logistic Regression ◽

Chinese Patients ◽

Hematoma Expansion ◽

West China Hospital ◽

West China ◽

Increased Risk

Abstract Background Whether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain. We evaluated the association between various liver fibrosis indices and substantial HE in a Chinese population with primary ICH. Methods Primary ICH patients admitted to West China Hospital within 24 h of onset between January 2015 and June 2018 were consecutively enrolled. Six liver fibrosis indices were calculated, including aspartate aminotransferase (AST)-platelet ratio index (APRI), AST/alanine aminotransferase ratio-platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and Forns index. Substantial HE was defined as an increase of more than 33% or 6 mL from baseline ICH volume. The association of each fibrosis index with substantial HE was analyzed using binary logistic regression. Results Of 436 patients enrolled, about 85% showed largely normal results on standard hepatic assays and coagulation parameters. Substantial HE occurred in 115 (26.4%) patients. After adjustment, AARPRI (OR 1.26, 95% CI 1.00-1.57) and FIB-4 (OR 1.15, 95% CI 1.02-1.30) were independently associated with substantial HE in ICH patients within 24 h of onset, respectively. In ICH patients within 6 h of onset, each of the following indices was independently associated with substantial HE: APRI (OR 2.64, 95% CI 1.30-5,36), AARPRI (OR 1.55, 95% CI 1.09-2.21), FIB-4 (OR 1.35, 95% CI 1.08-1.68), mFIB-4 (OR 1.09, 95% CI 1.01-1.18), FibroQ (OR 1.08, 95% CI 1.00-1.16) and Forns index (OR 1.37, 95% CI 1.10-1.69). Conclusions Liver fibrosis indices are independently associated with higher risk of substantial HE in Chinese patients with primary ICH, which suggesting that subclinical liver fibrosis could be routinely assessed in such patients to identify those at high risk of substantial HE.

Download Full-text

Abstract WP126: Association of 24-Hour Blood Pressure Parameters Post-Intravenous Alteplase With Symptomatic Intracerebral Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.wp126 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Toluwalase Tofade ◽

Ava Liberman ◽

Priyank Khandelwal

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Treatment Time ◽

Tertiary Care ◽

Significant Risk ◽

Binary Logistic Regression Analysis ◽

Symptomatic Intracerebral Hemorrhage ◽

Intravenous Alteplase ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Higher blood pressure (BP) at presentation is associated with a higher risk of symptomatic intracerebral hemorrhage (sICH) post-intravenous alteplase (IV-rtPA). We investigated the association of different BP parameters post-IV-rtPA with the development of sICH at a tertiary care center. Methods: We performed a retrospective chart review of adult patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the BP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the BP parameters as the predictors. The primary outcome was the development of sICH. SICH was defined as an intracerebral hemorrhage (ICH) that causes worsening of NIHSS score by ≥4 points post-IV-rtPA. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 5 (5.95%) patients developed sICH. In our cohort, the BP parameters of higher maximum systolic blood pressure (SBP) (195.8±9 vs.172.22±17; OR, 1.14; 95% CI, 1.03-1.26; P 0.016), higher maximum diastolic blood pressure (DBP) (120.2±18 vs.104.76±15; OR, 1.08; 95% CI, 1.01-1.17; P 0.04), wider SBP range (79.4±20 vs.58.75±18; OR, 1.06; 95% CI, 1.01-1.12; P 0.033), wider DBP range (74.2±27 vs.47.27±15; OR, 1.11; 95% CI, 1.03-1.2; P 0.008), and coefficient variation (CV) DBP (17.7±6 vs.12.65±4; OR, 1.19; 95% CI, 1.01-1.42; P 0.048) were significantly associated with a risk of sICH post IV-rtPA. Conclusions: Our study demonstrates significant risk of sICH with higher maximum SBP and DBP, wider SBP and DBP ranges, and CV DBP post-IV-rtPA.

Download Full-text

Abstract W P257: Predictors of the CT Angiography Spot Sign in Deep and Lobar Intracerebral Hemorrhage

Stroke ◽

10.1161/str.45.suppl_1.wp257 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Farid Radmanesh ◽

Guido J Falcone ◽

Christopher D Anderson ◽

Thomas W Battey ◽

Alison M Ayres ◽

...

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Cerebral Amyloid Angiopathy ◽

Symptom Onset ◽

Hematoma Expansion ◽

Amyloid Angiopathy ◽

Spot Sign ◽

Increased Risk ◽

Cerebral Amyloid

Objectives: Intracerebral hemorrhage (ICH) patients with CT angiography (CTA) spot sign are at increased risk of hematoma expansion and poor outcome. Since ICH is often the acute manifestation of a chronic cerebral vasculopathy, we investigated whether different clinical or imaging characteristics predict spot sign presence in patients with different underlying vasculopathies. Using ICH location as a surrogate for hypertension-related ICH and cerebral amyloid angiopathy-related ICH, we identified risk factors associated with spot sign. METHODS: We retrospectively analyzed a prospective cohort of consecutive spontaneous ICH patients with available CTA. Spot sign presence was ascertained by two independent readers blinded to clinical data. We assessed potential predictors of spot sign be performing uni- and multivariable logistic regression, analyzing deep and lobar ICH separately. RESULTS: 649 patients were eligible, 291 (45%) deep and 358 (55%) lobar ICH. Median time from symptom onset to CTA was 4.5 (IQR 5.2) and 5.7 (IQR 7.4) hours in patients with deep and lobar ICH, respectively. At least one spot sign was present in 76 (26%) deep and 103 (29%) lobar ICH patients. In mutivariable logistic regression, independent predictors of spot sign in deep ICH were warfarin (OR 2.82 [95%CI 1.06-7.57]; p=0.03), time from symptom onset to CTA (OR 0.9 [95%CI 0.81-0.97]; p=0.02), and baseline ICH volume (OR 1.27 [95%CI 1.14-1.43]; p=2.5E-5; per 10 mL increase). Predictors of spot sign in lobar ICH were preexisting dementia (OR 2.7 [95%CI 1.15-6.43]; p=0.02), warfarin (OR 4.01 [95%CI 1.78-9.29]; p=0.009), and baseline ICH volume (OR 1.27 [95%CI 1.17-1.39]; p=5.4E-8; per 10 mL increase). As expected, spot sign presence was a strong predictor of hematoma expansion in both deep (OR 3.52 [95%CI 1.72-7.2]; p=0.0005) and lobar ICH (OR 6.53 [95%CI 3.23-13.44]; p=2.2E-7). CONCLUSIONS: The most potent associations with spot sign are shared by deep and lobar ICH, suggesting that ICH caused by different vasculopathic processes share biological features. The relationship between preexisting dementia and spot sign in lobar ICH, but not deep ICH, suggests that ICH occurring in the context of more advanced cerebral amyloid angiopathy may be more likely to have prolonged bleeding.

Download Full-text

Abstract 1122‐000091: Predictors of Symptomatic Hemorrhagic Transformation After Mechanical Thrombectomy in Acute Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000091 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Anqi Luo ◽

Agnelio Cardenas ◽

Lee A Birnbaum

Keyword(s):

Risk Factors ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

Hemorrhagic Transformation ◽

Current Standard ◽

Vessel Occlusion ◽

Increased Risk ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Iv Tpa

Introduction : Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Although several studies have investigated the risk factors, there is still limited, not well‐established data. This study aims to evaluate the risk factors of HT after MT. Methods : We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 7/2019. Variables included initial NIHSS, blood glucose, initial systolic blood pressure, age, gender, IV tPA, time from door to recanalization, and TICI score. Outcome measures were HT on post‐procedure or 24‐hour post‐tPA head CT/MRI as well as modified Rankin scale (mRS) upon discharge. Results : Among 74 patients (68.8 ± 14 years, men 47.3%), 9 (12.2%) experienced hemorrhagic transformation after thrombectomy. Average admitting NIHSS was significantly higher in the HT group (22 vs 16.8, p = 0.041). TICI 3 after MT was protective for HT (OR 0.078, 95% CI 0.009‐0.663). IV tPA (OR 3.86, 95% CI 1.448‐10.326) was associated with good neurological outcome at discharge (mRS < = 2), but HT was not (OR 0.114, 95% CI 0.013‐0.964). Patients with mRS < = 2 upon discharge were younger (65.2±12 vs 71.9±15, p = 0.04) and had lower initial BG (124±45.8 vs 157±69.6, P = 0.02). Conclusions : TICI 3 score, decreased NIHSS, and lower BG were associated with less HT and better outcomes in our MT cohort. Admitting NIHSS > = 20 may be a reasonable threshold to predict HT after MT. Our findings are consistent with the TICI‐ASPECTS‐glucose (TAG) score to predict sICH; however, we used initial NIHSS as a surrogate for ASPECTS. Further studies may utilize additional quantitative measures such as CTP data to predict HT.

Download Full-text

Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

Surgical Neurology International ◽

10.25259/sni_100_2021 ◽

2021 ◽

Vol 12 ◽

pp. 277

Author(s):

Dimitri Laurent ◽

Olgert Bardhi ◽

Paul Kubilis ◽

Brian Corliss ◽

Stephanie Adamczak ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Hematoma Expansion ◽

Optimal Timing ◽

Thromboembolic Events ◽

Spontaneous Intracerebral Hemorrhage ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

Download Full-text

Liver Fibrosis Indices Associated with Substantial Hematoma Expansion in Chinese Patients with Primary Intracerebral Hemorrhage

10.21203/rs.3.rs-666991/v1 ◽

2021 ◽

Author(s):

Huan Wang ◽

Jiongxing Wu ◽

Xue Yang ◽

Junfeng Liu ◽

Wendan Tao ◽

...

Keyword(s):

Logistic Regression ◽

Liver Fibrosis ◽

Intracerebral Hemorrhage ◽

Chinese Population ◽

Binary Logistic Regression ◽

Chinese Patients ◽

Hematoma Expansion ◽

West China Hospital ◽

West China ◽

Increased Risk

Abstract Background: Whether liver fibrosis is associated with increased risk for substantial hematoma expansion (HE) after intracerebral hemorrhage (ICH) is still uncertain. We evaluated the association between various liver fibrosis indices and substantial HE in a Chinese population with primary ICH.Methods: Primary ICH patients admitted to West China Hospital within 24 hours of onset between January 2015 and June 2018 were consecutively enrolled. Six liver fibrosis indices were calculated, including aspartate aminotransferase (AST)-platelet ratio index (APRI), AST/alanine aminotransferase ratio-platelet ratio index (AARPRI), fibrosis-4 (FIB-4), modified fibrosis-4 (mFIB-4), fibrosis quotient (FibroQ) and Forns index. Substantial HE was defined as an increase of more than 33% or 6 mL from baseline ICH volume. The association of each fibrosis index with substantial HE was analyzed using binary logistic regression. Results: Of 436 patients enrolled, about 85% showed largely normal results on standard hepatic assays and coagulation parameters. Substantial HE occurred in 115 (26.4%) patients. After adjustment, AARPRI (OR 1.26, 95% CI 1.00-1.57) and FIB-4 (OR 1.15, 95% CI 1.02-1.30) were independently associated with substantial HE in ICH patients within 24h of onset, respectively. In ICH patients within 6h of onset, each of the following indices was independently associated with substantial HE: APRI (OR 2.63, 95% CI 1.30-5,34), AARPRI (OR 1.55, 95% CI 1.09-2.22), FIB-4 (OR 1.35, 95% CI 1.08-1.69), mFIB-4 (OR 1.09, 95% CI 1.01-1.18), FibroQ (OR 1.08, 95% CI 1.00-1.16) and Forns index (OR 1.37, 95% CI 1.10-1.69). Conclusions: Liver fibrosis indices are independently associated with higher risk of substantial HE in Chinese patients with primary ICH, which suggesting that subclinical liver fibrosis could be routinely assessed in such patients to identify those at high risk of substantial HE.

Download Full-text

Abstract 1122‐000179: Very Low Rates of Intracerebral Hemorrhage in Patients Transferred for Mechanical Thrombectomy

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000179 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Yazan Radaideh

Keyword(s):

Intracerebral Hemorrhage ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Vessel Occlusion ◽

Single Center Experience ◽

True Value ◽

Intravenous Alteplase ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Repeat Imaging

Introduction : Background: A common convention among stroke patients being transferred for mechanical thrombectomy, particularly if intravenous thrombolysis has been given, is to undergo a repeat plain brain CT at the treating stroke center. The most concerning among several concerns is the discovery of intracerebral hemorrhage (ICH) which would obviate the value of thrombectomy. This practice has been shown in a previous series to result in a median treatment delay of 20 minutes[1]. By determining the actual incidence of any ICH seen on neuroimaging in patients who undergo repeat imaging on arrival to comprehensive stroke center prior to intervention, we can better determine the true value of this convention of repeat imaging. Methods : Retrospective review of all patients transferred to a single academic comprehensive stroke center for mechanical thrombectomy. We evaluated for the frequency of repeat imaging, the rate of ICH and the rate of undergoing mechanical thrombectomy. Results : There were 682 patients transferred directly for mechanical thrombectomy evaluation over the study period. Intravenous Alteplase was administered to 391 patients prior to arrival and 2 had it on arrival to destination hospital. Plain head CT was repeated at the hub hospital in 590/682 patients (86.5%) (348 with thrombolytics and 242 without. A new intracerebral hemorrhage (ICH) was detected in 9 patients. In only 3 of the 9 patients was mechanical thrombectomy deferred solely due to the ICH (other 6 had no evidence of LVO (4), low ASPECTS (1) or exam improvement (1)). Conclusions : In patients being transferred for mechanical thrombectomy, the rate of ICH on arrival to site hospital was 1.5%. In only one third of those patients (0.5%) was the decision to not proceed with mechanical thrombectomy related to the new ICH. Given the delays in door to puncture times associated with repeat imaging indicated in literature and the low yield in detecting ICH in transfer patients, repeating neuroimaging at comprehensive stroke center obtained for the purpose of ruling out ICH on patients transferred for MT should be reconsidered. Limitations: Our study reflects a single center experience. Other indications for repeat imaging at comprehensive stroke center such as assessment of infarcted core, and presence of large vessel occlusion might still warrant repeat imaging at comprehensive stroke center.

Download Full-text

Abstract TP220: Is Fibrinogen a Reliable Lab to Follow in Acute Ischemic Stoke After Thrombolysis

Stroke ◽

10.1161/str.48.suppl_1.tp220 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Deepak Gulati ◽

Muhammad Nasir ◽

Dharti Dua ◽

Michel Torbey

Keyword(s):

Reference Range ◽

Fibrinogen Level ◽

Heart Association ◽

Bleeding Complications ◽

Hematoma Expansion ◽

Normal Reference Range ◽

Single Center Experience ◽

The Mean ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: American Heart Association suggests empirical therapies (cryoprecipitate, FFP and platelets) for post-IVtpa hemorrhage but acknowledges the lack of evidence to support any specific therapy. Different institutions have developed care pathways for post-IVtpa sICH involving frequent fibrinogen level checks. During thrombolysis, circulating fibrinogen is decreased, and thus rapid administration of cryoprecipitate is recommended. A marker of fibrinogen of <100-150 mg/dL has been traditionally used as a cutoff to suggest effective thrombolysis or administration of cryoprecipitate or to assess the risk of bleeding complications. Monitoring of fibrinogen level has been used to guide the reversal therapy in the setting of post-IVtpa hemorrhage. This practice is not fully addressed in the literature. Purpose: To determine the significance of fibrinogen level in relation to thrombolysis in acute ischemic stroke (AIS) based on our single center experience. Methods: We retrospectively reviewed fibrinogen levels in two groups of patients with AIS who presented to our comprehensive stroke center. First group included 50 patients who received IVtpa including two patients w/ post-IVtpa sICH and second group included 50 patients with AIS who could not receive IVtpa due to contraindication. Fibrinogen level was checked in immediate post-IVtpa period usually within 2hr of IVtpa or 6hr from onset. Results: The mean fibrinogen level in first group with patients with AIS who received IVtpa is 321.65 mg/dl with range from 102 to 533 mg/dl. Normal reference range is 220-410mg/dl. The mean fibrinogen level in second group without IVtpa is 376mg/dl with range from 124 to 583mg/dl. The fibrinogen level in two patients with post-IVtpa sICH was 216 and 282 mg/dl. Conclusions: No significant correlation is found between fibrinogen level (<100mg/dl) and IVtpa use. We also found no significant change in fibrinogen level in patients with post-IVtpa sICH even though there are only two cases included so far. Above finding suggests that we should focus our research on mechanism other than decrease fibrinogen level to be an underlying cause of post-IVtpa hemorrhage in order to develop agent for better reversal and to prevent continued hematoma expansion.

Download Full-text