HT is an infrequent but potentially devastating complication of thrombolytic therapy in AIS for which there are no reliable biomarkers. rtPA is known to create a consumptive coagulopathy with depletion of fibrinogen. We evaluated fibrinogen levels as a potential predictor of HT after rtPA.

This is a retrospective case-control study of 72 adult patients with imaging-confirmed AIS consisting of 36 patients with imaging-proven HT and 36 NIHSS-matched controls. All patients received rtPA alone or in combination with mechanical thrombectomy (MT) where appropriate. Fibrinogen was collected at baseline, and serially at 6 ± 2-hour intervals after administration of rtPA for a total of 24 hours post treatment.

Median baseline fibrinogen levels were equivalent across the two groups, at 254 mg/dL in the HT group and 262 mg/dL (p=0.621) in the control group. Lowest median fibrinogen level occurred within the first 12 hours post treatment, corresponding to 184 mg/dL and 264 mg/dL (p=0.002) in the HT and control groups, respectively. The difference in fibrinogen level persisted for 24 hours post rtPA (median 221 mg/dL in the HT group and 260 mg/dL in the control group, p=0.257), but lost statistical significance beyond the first 12 hours.