Karl L. Resch, MD; Edward Ernst, MD; Arpad Matrai, MD, PhD; Hans F. Paulsen, MD
▪ Objective: To investigate whether abnormalities in blood viscosity predict a poor prognosis for subsequent cardiovascular events in stroke survivors.
▪ Design: Nested case-control study among a cohort of survivors of a first stroke, followed for an average of 2 years. Patients with a second stroke, myocardial infarction, or cardiovascular death were matched with patients who did not have such events (control patients).
▪ Setting: Buchberg-Klinik, Bad Tölz, Germany, a specialized center for stroke rehabilitation.
▪ Patients: A total of 625 consecutive patients. Twenty-one patients (3.5%) were lost to follow-up. Sixty pairs were matched.
▪ Measurements: Native and hematocrit-standardized blood viscosity at three shear rates, hematocrit, plasma viscosity, fibrinogen, erythrocyte sedimentation rate, total leukocyte count, and the matching variables.
▪ Results: Eighty-five patients had a second stroke, myocardial infarction, or died due to a cardiovascular event. Patients with re-events had higher blood viscosity and fibrinogen levels than the control patients. In the 60 matched pairs, the mean of the paired differences between patients with re-events and control patients was 5.03 mPa · s (95% Cl, 1.262 to 8.941; P = 0.01) for native blood viscosity at shear rate 0.7 s-1, for plasma viscosity, 0.044 mPa · s (Cl, 0.006 to 0.083; P > 0.02), and for fibrinogen, 0.056 g/L (Cl, 0.010 to 0.101; P > 0.02). Odds ratios were significantly increased only for plasma viscosity (odds ratio, 2.86; Cl, 1.06 to 8.43) and fibrinogen (odds ratio, 3.67; Cl, 1.31 to 11.69).
▪ Conclusions: Hyperfibrinogenemia is an independent risk factor for cardiovascular events in stroke survivors. Intervention trials with fibrinogen lowering measures may be warranted.
Resch KL, Ernst E, Matrai A, Paulsen HF. Fibrinogen and Viscosity as Risk Factors for Subsequent Cardiovascular Events in Stroke Survivors. Ann Intern Med. ;117:371–375. doi: 10.7326/0003-4819-117-5-371
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Published: Ann Intern Med. 1992;117(5):371-375.
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