Fibrinogen as a predictor of intracranial hemorrhage after intravenous thrombolysis in ischemic stroke

Czech version

Authors: L. Šimůnek ^1,2; V. Kunešová ³; R. Mikulík ⁴; R. Herzig ^1,2
Authors‘ workplace: Neurologická klinika, Lékařská fakulta v Hradci Králové, Univerzita Karlova, Hradec Králové ¹; Neurologická klinika, Komplexní cerebrovaskulární centrum, Fakultní nemocnice Hradec Králové, Hradec Králové ²; Centrum Excelence CREATIC, Lékařská fakulta, Masarykova univerzita, Brno ³; Neurologické oddělení, Krajská nemocnice T. Bati, a. s., Zlín ⁴
Published in: Cesk Slov Neurol N 2026; 89(1): 63-67
Category: Study protocol
doi: https://doi.org/10.48095/cccsnn202663

Overview

Background and objective: Although intravenous thrombolysis (IVT) is a recommended recanalization therapy for ischemic stroke, it is associated with a risk of symptomatic intracranial hemorrhage. This academic clinical study aims to evaluate the relationship between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of intracranial hemorrhage, specifically parenchymal hematoma, which is the most clinically significant type of intracranial hemorrhage. Methods: Seven primary stroke centers and comprehensive stroke centers in the Czech Republic will be involved in the multicenter retrospective study. The estimated total number of patients enrolled in the observation and control groups is 300, with defined entry parameters maintained. The parameters monitored include personal and pharmacological history, laboratory parameters, neurological findings, and imaging results. Results: The study will evaluate the degree of association between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of parenchymal hematoma. Conclusion: Evidence of an association between the development of parenchymal hematoma and a decrease in fibrinogen levels in patients with ischemic stroke treated with IVT may be used to design an interventional study with fibrinogen replacement to prevent bleeding.

Keywords:

stroke – ischemia – intravenous thrombolysis – intracranial hemorrhage – fi brinogen – parenchymal hematoma

Sources

1. Brunström M, Carlberg B. Thrombolysis in acute stroke. Lancet 2015; 385 (9976): 1394–1395. doi: 10.1016/S0140-6736 (15) 60715-2.

2. Tsivgoulis G, Kargiotis O, De Marchis G et al. Off-label use of intravenous thrombolysis for acute ischemic stroke: a critical appraisal of randomized and real-world evidence. Ther Adv Neurol Disord 2021; 14 : 1–29. doi: 10.1177/1756286421997368.

3. Emberson J, Lees KR, Lyden P et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384 (9958): 1929–1935. doi: 10.1016/S0140-6736 (14) 60584-5.

4. von Kummer R, Broderick JP, Campbell BCV et al. The Heidelberg bleeding classification: Classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 2015; 46 (10): 2981–6. doi: 10.1161/STROKEAHA.115.010049.

5. Neumann J, Šaňák D, Tomek A et al. Doporučení pro intravenózní trombolýzu v léčbě akutního mozkového infarktu –⁠ verze 2021. Cesk Slov Neurol N 2021; 84/117 (3): 291–299. doi: https: //doi.org/10.48095/cccsnn2021291.

6. Shinton R. Questions about authorisation of alteplase for ischaemic stroke. Lancet 2014; 384 : 659–666. doi: 10.1016/S0140-6736 (14) 61385-4.

7. Alper BS, Malone-Moses M, McLellan JS et al. Thrombolysis in acute ischaemic stroke: time for a rethink? BMJ 2015; 350 : 1075. doi: 10.1136/bmj.h1075.

8. Larrue V, von Kummer R, Müller A et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator. Stroke 2001; 32 : 438–441. doi: 10.1161/01.str.32.2.438.

9. Whiteley WN, Emberson J, Lees KR et al. Risk of intracerebral haemorrhage with lase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis. Lancet Neurol 2016; 15 (9): 925–933. doi: 10.1016/S1474-4422 (16) 30076-X.

10. Kellert L, Sykora M, Gumbinger C et al. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome. Cerebrovasc Dis 2012; 33 (2): 135–40. doi: 10.1159/000334186.

11. Stangl K, Laule M, Tenckhoff B et al. Fibrinogen breakdown, long-lasting systemic fibrinolysis, and procoagulant activation during alteplase double-bolus regimen in acute myocardial infarction. Am J Cardiol 1998; 81 : 841–847. doi: 10.1016/s0002-9149 (98) 00018-6.

12. Goldemund D. Cerebrovaskulární manuál: Trombolytické protokoly. [online]. Dostupné z: https: //www.manual-cmp.cz/trombolyticke-protokoly. [Cit. 2025 -⁠ 12-13]

13. Powers WJ, Rabinstein AA, Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 Guidelines for the early management of acute ischemic stroke: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12): 344–418. doi: 10.1161/STR.0000000000 000211.