The Role Of Fibrinogen-depleting Therapy In The Second Prevention Of Ischemic Stroke

Objective To observe the plasma fibrinogen level after fibrinogen-depleting drug treatment in patients with ischemic stroke, as well as the effect on the change of carotid atherosclerosis and the incidence rate of vascular events; to assess the role of fibrinogen-depleting therapy in the second prevention of ischemic stroke.Methods A multi-centre, parallel, controlled clinical trial was conducted of hospitalized patients with ischemic stroke in 11 hospitals of Suzhou from 2007 to 2009. They were divided into either control group that received a conventional neurology treatment or fibrinogen-depleting group that also received Lumbrokinase ( 600000 units, oral, three times per day ). They were followed up for 12 months. The level of plasma fibrinogen ( Fg ) was detected before and after treatment. The length and width diameter of atherosclerosis plaque, the plaque number, the plaque location, the plaque echo intensity, the carotid artery intima-media thickness ( IMT ) and the carotid artery inner diameter were detected by the color doppler ultrasound instrument before and after treatment, the plaque detection rate, the plaque volume and the vulnerable plaque detection rate before and after treatment were calculated according to the doppler reports. The NIH Stroke Scale ( NIHSS ) were recorded before and after treatment. The incidence rate of vascular event was caculated after treatment. C-response protein ( CRP ), fibrinolytic system ( including tissue plasminogen activator, plasminogen activator inhibitor-1 and D-dimer ), coagulation function indexes, and hemorheology indexes were also assessed.Results A total of 310 patients were enrolled in the trial finally, 192 to the fibrinogen-depleting group and 118 to the control group. Changes of Fg, both sides IMT, both sides plaque volume, the vulnerable plaque detection rate, the NIHSS and the incidence rate of the vascular events had statistically very significant differences ( P<0.05 ) in the fibrinogen-depleting groups; with significant difference between the two groups included Fg, both sides IMT, both sides plaque volume, the vulnerable plaque detection rate and the NIHSS of the two groups ( P<0.05 ). The mean plaque volume was strongly related with the plaque length and width, the plaque number, the IMT, and the low-shear whole blood viscosity ( P<0.01 ), as well as weak-ralated with the level of Fg ( P=0.056 ).Conclusion Long term oral fibrinogen-depleting therapy in patients with ischemic stroke can significantly reduce the Fg levels in plasma, reduce levels of D-dimer and C-response protein in serum, increase blood fibrinolytic activity, improve the prognosis of atherosclerosis, improve the prognosis of neurological function, as well as effectively reduce the incidence rate of both vascular events and the cerebrovascular events.