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WCN 2021 | Fibrinogen depletion in ischemic stroke predicts bleeding

Intracerebral hemorrhage and major bleeding can be fatal complications of intravenous thrombolysis for acute ischemic stroke. Michele Romoli, MD, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy, discusses the potential for fibrinogen repletion following thrombolysis to reduce the risk of bleeding in ischemic stroke patients. Alteplase-induced thrombolysis may produce steep drops in fibrinogen levels, an important factor for blood coagulation. Results of a multicenter, observational study in Italy suggest that fibrinogen levels can begin to drop two hours after alteplase-induced thrombolysis. Importantly, hemorrhage was four times as likely to occur in stroke patients with drastically reduced fibrinogen levels. These results suggest that intravenous fibrinogen repletion may reduce the risk of bleeding in these patients. This is currently being investigated in a pilot clinical trial. This interview took place during the XXV World Congress of Neurology (WCN).