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

 

So you predicted a problem, WHAT THE FUCK IS THE SOLUTION TO PREVENT IT? My directors would never let me get away with describing a problem without having a possible solution in hand. I'd be fired in no time.

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

Changchun Lin^†, Hui Pan^†, Yuan Qiao, Peisheng Huang, Jingjing Su^* and Jianren Liu^*

• Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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.

Introduction

Acute ischemic stroke (AIS) is the leading cause of long-term disability in developed countries and the leading cause of mortality worldwide (1). Mechanical thrombectomy (MT) has become the standard of care for patients with acute intracranial large-vessel occlusion. With the DIFFUSE 3 and DAWN trials extending the time window to up to 24 h, more AIS patients are now eligible for MT (2, 3). Hemorrhagic transformation (HT), a common and severe complication, is usually associated with a poor functional outcome, or even death, after MT and has a reported incidence of up to 46.1% in clinical MT trials (4). Therefore, identifying risk factors for HT could help guide patient selection for MT, which will improve procedural safety and clinical outcomes.

Studies have examined possible risk factors for HT in the setting of MT in AIS patients. Li et al. (5) found that a higher National Institutes of Health Stroke Scale (NIHSS) score, increased systolic blood pressure, history of coronary heart disease, and use of intravenous thrombolysis or oral anti-platelet or anticoagulation drugs were associated with HT in patients undergoing MT. Moreover, ischemic volume, cerebral collateral circulation, baseline Alberta Stroke Program Early CT Score (ASPECTS), and delayed endovascular treatment are associated with an increased risk of HT after MT (6–8). However, most of these risk factors are assessed using clinical and imaging data (9) that are complex and subjective. Hence, it is necessary to identify blood biomarkers that can accurately predict HT after MT.

Studies of blood biomarkers have shown that blood glucose, lipid profiles, bilirubin, aminotransferase, alkaline phosphatase, globulin, biomarkers of disruption of the blood–brain barrier (BBB) (10), inflammation and oxidative stress (11), vasoreactivity (12), and coagulation/fibrinolysis disorder (13–15) are associated with HT in AIS patients (16). These biomarkers may reflect the pathophysiology of HT. However, most of these studies are on thrombolysis treatments, and there are limited data on blood biomarkers and the clinical relevance of HT in the setting of MT.

Platelet and fibrinogen are well-known biomarkers of the coagulation system. Fibrinogen level and platelet counts are proven to be associated with HT in AIS patients after thrombolysis (14, 17, 18). However, research about biomarkers and HT after AIS in the setting of MT is relatively less. Therefore, this study examined blood biomarkers that predict HT in AIS patients after reperfusion to provide reference data facilitating patient selection for MT.

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