[en] [en] BACKGROUND: Hemorrhagic transformation (HT) frequently occurs in acute ischemic stroke patients with a large vessel occlusion undergoing endovascular therapy (EVT), significantly impacting functional outcomes. We aimed to determine whether an early fibrinogen depletion coagulopathy (FDC) was associated with HT following bridging therapy (ie, intravenous thrombolysis [IVT] followed by EVT), and to identify its associated factors.
METHODS: We retrospectively analyzed prospectively collected data from 296 patients with acute ischemic stroke with a large vessel occlusion who underwent EVT alone or bridging therapy, with fibrinogen levels measured both before baseline imaging and at the start of the EVT procedure. FDC was defined as a fibrinogen level <2.0 g/L at the start of the EVT procedure, with an absolute decrease >1.0 g/L from baseline. The primary outcome was the occurrence of any HT at 24 to 36 hours. Secondary outcomes included symptomatic HT, parenchymal hematomas, and 3-month mortality. The relationships between FDC and outcomes were studied using multivariable logistic regression analyses, adjusting for relevant confounders. We also studied baseline characteristics associated with FDC occurrence.
RESULTS: Of the 296 patients enrolled, 102 (34.5%) experienced HT, and 54 (18.2%) developed FDC. FDC was strongly associated with IVT use (53/161 [32.9%] versus 1/135 [0.7%] in IVT-treated and non-IVT-treated patients, respectively; P<0.01). In patients receiving bridging therapy, FDC occurrence was independently associated with any HT (adjusted odds ratio, 2.33 [95% CI, 1.11-4.91]), symptomatic HT (adjusted odds ratio, 3.35 [95% CI, 1.20-9.40]), parenchymal hematomas (adjusted odds ratio, 2.87 [95% CI, 1.14-7.24]), and 3-month mortality (adjusted odds ratio, 3.82 [95% CI, 1.47-9.93]). None of the 26 patients who received tenecteplase experienced FDC, compared with 53 of 135 (39.3%) patients treated with alteplase (P<0.01).
CONCLUSIONS: Following bridging therapy, FDC is a frequent event associated with increased risks of any HT, symptomatic HT, parenchymal hematomas, and 3-month mortality. FDC did not occur following IVT with tenecteplase in our cohort, suggesting that the fibrin specificity of thrombolytic agents may play a pivotal role in its development.
Disciplines :
Neurology
Author, co-author :
Pauillac, Naëiri ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Department of Neurology (N.P., P.S.), A. Rothschild Foundation Hospital, Paris, France
Faille, Dorothée ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Biological Hematology Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France (D.F
Solo Nomenjanahary, Mialitiana; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D
Souvanheuane, Mélanie; Neuroradiology Department (M.S.), A. Rothschild Foundation Hospital, Paris, France
Brikci-Nigassa, Nahida; Interventional Neuroradiology Department and Biological Resources Center (N.B.-N., F.D., B.M., M.M., J.-P.D.), A. Rothschild Foundation Hospital, Paris, France
Ameri, Alain; Department of Neurology, Est Francilien Hospital Group (GHEF), Meaux, France (A.A
Benoit, Tristan; Department of Neurology, Robert Ballanger Hospital, Aulnay-sous-Bois, France (T.B
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology Department and Biological Resources Center (N.B.-N., F.D., B.M., M.M., J.-P.D.), A. Rothschild Foundation Hospital, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S
Maier, Benjamin ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Interventional Neuroradiology Department and Biological Resources Center (N.B.-N., F.D., B.M., M.M., J.-P.D.), A. Rothschild Foundation Hospital, Paris, France ; Department of Neurology, Saint-Joseph Hospital, Paris, France (B.M ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S
Ho-Tin-Noé, Benoit ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S
Mazighi, Mikael ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Interventional Neuroradiology Department and Biological Resources Center (N.B.-N., F.D., B.M., M.M., J.-P.D.), A. Rothschild Foundation Hospital, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S ; FHU NeuroVasc, Paris, France (M.M., J.-P.D., P.S ; Institut Universitaire de France (M.M
Desilles, Jean-Philippe ; Paris Cité University, Therapeutic Optimization in Neuropharmacology, U1144 INSERM, France (N.P., D.F., M.S.N., B.M., B.H.-T.-N., M.M., J.-P.D ; Interventional Neuroradiology Department and Biological Resources Center (N.B.-N., F.D., B.M., M.M., J.-P.D.), A. Rothschild Foundation Hospital, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S ; FHU NeuroVasc, Paris, France (M.M., J.-P.D., P.S
Seners, Pierre ; Department of Neurology (N.P., P.S.), A. Rothschild Foundation Hospital, Paris, France ; Stroke-Link F-CRIN Research Network, Lille, France (F.D., B.M., B.H.-T.-N., M.M., J.-P.D., P.S ; FHU NeuroVasc, Paris, France (M.M., J.-P.D., P.S ; Paris Cité University, Institute of Psychiatry and Neuroscience of Paris, U1266 INSERM, Paris, France (P.S
This study was supported by the french National Institutes of Health and Medical Research (INSERM) MESSIDORE SAVE-BRAIN and the National Research Agency under grant agreement No. ANR-18-RHUS-0001 (RHU Booster) and ANR-22-CE17-0032 (INFLAME).
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