Is Plasma Fibrinogen Useful in Evaluating Ischemic Stroke Patients?

See related article, pages 1687–1691. In this issue of Stroke , del Zoppo et al1 report new data on the association between hyperfibrinogenemia and functional prognosis after ischemic stroke using the placebo data from 2 well-known clinical interventional trials on the use of defibrinogenating agent ancrod in acute ischemic stroke.2,3 Briefly, the authors explore the relationship of fibrinogen with the ischemic stroke outcome showing that patients with lower initial fibrinogen levels (<4.5 g/L) had better functional outcomes even when corrected for age and initial stroke severity.1 They confirmed a relationship between fibrinogen and prognosis independent of other cardiovascular risk factors and stroke severity.4,5Because patients at risk for the development of fibrinogen-related ischemic complications of atherosclerosis can be easily identified and nonpharmacological treatment (cessation of smoking, diet, exercise) seems to lower raised fibrinogen levels together with several drugs (fibrates, Ω3 fatty acids, ticlopidine, pentoxifylline, defibrotide),6 clinically oriented secondary prevention recommendations7 should consider the role of fibrinogen in ischemic stroke. The clinical use of fibrinogen measurement should be based on (1) evidence regarding the ability of fibrinogen to predict ischemic stroke prognosis beyond that of current prognostic prediction methods or models, and (2) evidence regarding the use of prognosis prediction to treatment of ischemic stroke.6A large body of well-done studies demonstrates an association between fibrinogen levels and ischemic stroke prognosis.1,4,5,8–18 There are, however, uncertainties in the exact role that fibrinogen plays in the determining ischemic stroke prognosis and the reliability of fibrinogen assessment. Because fibrinogen concentrations remain associated with ischemic stroke prognosis after adjustment for many known prognostic risk factors, including age, stroke severity, and neuroradiological findings, it follows that a prognostic prediction model that adds fibrinogen would provide more accurate assessment of ischemic stroke prognosis. Whether this improved accuracy …