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Early changes in fibrinogen after administration of alteplase are associated with the short-term efficacy of thrombolysis.

Abstract The authors aimed to determine whether early changes in fibrinogen were associated with the efficacy of intravenous thrombolysis at 24 hours after alteplase infusion. The authors retrospectively reviewed a consecutive series of 56 patients with acute ischemic stroke treated with alteplase in the clinical database. The fibrinogen levels were monitored at the first and fourth hours after alteplase infusion. Additionally, the National Institutes of Health Stroke Scale (NIHSS) scores were recorded to define the short-term efficacy of intravenous thrombolysis before and 24 hours after alteplase infusion. The patients were distributed into amelioration, deterioration, and inefficiency groups according the short-term efficacy of intravenous thrombolysis. One-way ANOVA and post hoc analysis were used to compare the differences in the clinical characteristics among these groups. The relationships among changes in the fibrinogen levels, other potential risk factors, and NIHSS scores were examined using logistic regression analysis. Fifty-two patients (mean age, 65.71 ± 11.04 years; male, 57.7%) were finally enrolled in the study. The median NIHSS of these patients was 11 (range, 2-23), and the mean time from symptom onset to thrombolysis was 187.17 ± 67.53 minutes. The frequency of hypertension in the deterioration group was significantly higher than that in the inefficiency group (P = .01). Changes in the fibrinogen level were more significant in the amelioration group than in the other groups (P < .05). Logistic regression analysis revealed that changes in the fibrinogen levels between the first and fourth hours were positively associated with the short-term efficacy of alteplase infusion (odds ratio, 3.98; 95% confidence interval, 1.56-10.16; P = .004). Early changes in fibrinogen levels may be a potential predictor for the short-term efficacy of alteplase treatment in acute ischemic stroke. Additionally, these changes may be helpful for determining the short-term efficacy of alteplase treatment and early therapeutic strategies in clinical practice.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29595678
OWN - NLM
STAT- MEDLINE
DCOM- 20180411
LR  - 20180411
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 13
DP  - 2018 Mar
TI  - Early changes in fibrinogen after administration of alteplase are associated with
      the short-term efficacy of thrombolysis.
PG  - e0241
LID - 10.1097/MD.0000000000010241 [doi]
AB  - The authors aimed to determine whether early changes in fibrinogen were
      associated with the efficacy of intravenous thrombolysis at 24 hours after
      alteplase infusion. The authors retrospectively reviewed a consecutive series of 
      56 patients with acute ischemic stroke treated with alteplase in the clinical
      database. The fibrinogen levels were monitored at the first and fourth hours
      after alteplase infusion. Additionally, the National Institutes of Health Stroke 
      Scale (NIHSS) scores were recorded to define the short-term efficacy of
      intravenous thrombolysis before and 24 hours after alteplase infusion. The
      patients were distributed into amelioration, deterioration, and inefficiency
      groups according the short-term efficacy of intravenous thrombolysis. One-way
      ANOVA and post hoc analysis were used to compare the differences in the clinical 
      characteristics among these groups. The relationships among changes in the
      fibrinogen levels, other potential risk factors, and NIHSS scores were examined
      using logistic regression analysis. Fifty-two patients (mean age, 65.71 +/- 11.04
      years; male, 57.7%) were finally enrolled in the study. The median NIHSS of these
      patients was 11 (range, 2-23), and the mean time from symptom onset to
      thrombolysis was 187.17 +/- 67.53 minutes. The frequency of hypertension in the
      deterioration group was significantly higher than that in the inefficiency group 
      (P = .01). Changes in the fibrinogen level were more significant in the
      amelioration group than in the other groups (P &lt; .05). Logistic regression
      analysis revealed that changes in the fibrinogen levels between the first and
      fourth hours were positively associated with the short-term efficacy of alteplase
      infusion (odds ratio, 3.98; 95% confidence interval, 1.56-10.16; P = .004). Early
      changes in fibrinogen levels may be a potential predictor for the short-term
      efficacy of alteplase treatment in acute ischemic stroke. Additionally, these
      changes may be helpful for determining the short-term efficacy of alteplase
      treatment and early therapeutic strategies in clinical practice.
FAU - Lu, Tao
AU  - Lu T
FAU - Xian, Wenbiao
AU  - Xian W
AD  - Department of Neurology, National Key Clinical Department and Key Discipline of
      Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major
      Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University,
      Guangzhou.
FAU - Liang, Jiahui
AU  - Liang J
AD  - Department of Neurology, National Key Clinical Department and Key Discipline of
      Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major
      Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University,
      Guangzhou.
FAU - Yang, Hong
AU  - Yang H
FAU - Weng, Baohui
AU  - Weng B
AD  - Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of
      Guangxi Medical University, Liuzhou, Guangxi, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Biomarkers)
RN  - 0 (Fibrinolytic Agents)
RN  - 9001-32-5 (Fibrinogen)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers
MH  - Comorbidity
MH  - Female
MH  - Fibrinogen/*drug effects
MH  - Fibrinolytic Agents/administration &amp; dosage/pharmacology/*therapeutic use
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke/*drug therapy/mortality
MH  - Time Factors
MH  - Tissue Plasminogen Activator/administration &amp; dosage/pharmacology/*therapeutic
      use
EDAT- 2018/03/30 06:00
MHDA- 2018/04/12 06:00
CRDT- 2018/03/30 06:00
PHST- 2018/03/30 06:00 [entrez]
PHST- 2018/03/30 06:00 [pubmed]
PHST- 2018/04/12 06:00 [medline]
AID - 10.1097/MD.0000000000010241 [doi]
AID - 00005792-201803300-00051 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Mar;97(13):e0241. doi: 10.1097/MD.0000000000010241.