Fibrinogênio como fator de risco independente de doença vascular cerebral

Fukujima, Marcia Maiumi; Martinez, Tânia Leme da Rocha; Pinto, Leonor do Espírito Santo de Almeida; Auriemo, Caio R.C.; Andrade, Luiz Augusto Franco de

doi:10.1590/S0004-282X1997000500009

Resumos

No protocolo de avaliação clínico-laboratorial de pacientes com acidente vascular cerebral (AVC) aterotrombótico dosamos e analisamos níveis de fibrinogênio plasmático (técnica de Clauss automatizada), para determinar seu possível papel como fator de risco trombogênico em 29 pacientes (20 homens e 9 mulheres) com idades entre 25 a 79 anos (mediana=55); todos tinham tido AVC aterotrombótico. Eles foram classificados em 2 grupos segundo alterações de fluxo nas carótidas: g1 - sem alteração de fluxo (n=19) e g2- com alteração de fluxo (n=10). Resultados- A média das dosagens de fibrinogênio no gl foi de 269 e no g2 de 353 mg/dl. Quarenta e sete por cento dos pacientes do gl e 80% do g2, apresentaram medidas >300 mg/dl. As diferenças obtidas entre os grupos neste estudo foram significantes. Conclusão- Considerando o nível de risco epidemiológico de 300 mg/dl, nossos resultados sugerem que o fibrinogênio é um fator de risco independente para AVC aterotrombótico, especialmente naqueles com alteração de fluxo carotídeo.

doença cerebrovascular; fibrinogênio; fator de risco; ultra-sonografia carotídea

We have studied fibrinogen levels (Clauss technique) in atherothrombotic ischemic stroke patients, in order to determine its role as a thombogenic risk factor. Twenty nine patients (20 men and 9 women) between 25 and 79 years old were studied; they all have had a atherothrombotic stroke. They were classified into two groups according to the result of their carotid doppler ultrasonography: g1 - without carotid flow reduction (n=l 9) and g2 - with carotid flow reduction (n=10). The fibrinogen mean value was 269mg/dl in gl and 353 mg/dl in g2. There were 47% of patients in gl and 80% of patients in g2 who presented levels >300 mg/dl. The proportions of the groups were significantly different (p<0,05). Considering the epidemiological value of 300 mg/dl, we conclude that the fibrinogen can be an independent risk factor for ischemic atherothrombotic stroke, specially in those whose carotid flow is reduced.

stroke; cerebrovascular disease; fibrinogen; risk factor; carotid ultrasonography

Fibrinogênio como fator de risco independente de doença vascular cerebral

Fibrinogen as independent risk factor for ischemic stroke

Marcia Maiumi Fukujima^I; Tânia Leme da Rocha Martinez^II; Leonor do Espírito Santo de Almeida Pinto^II; Caio R.C. Auriemo^II; Luiz Augusto Franco de Andrade^I

^IEscola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP). Disciplina de Neurologia

^IIEscola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP). Setor de Lípides do Departamento de Medicina

RESUMO

No protocolo de avaliação clínico-laboratorial de pacientes com acidente vascular cerebral (AVC) aterotrombótico dosamos e analisamos níveis de fibrinogênio plasmático (técnica de Clauss automatizada), para determinar seu possível papel como fator de risco trombogênico em 29 pacientes (20 homens e 9 mulheres) com idades entre 25 a 79 anos (mediana=55); todos tinham tido AVC aterotrombótico. Eles foram classificados em 2 grupos segundo alterações de fluxo nas carótidas: g1 - sem alteração de fluxo (n=19) e g2- com alteração de fluxo (n=10). Resultados- A média das dosagens de fibrinogênio no gl foi de 269 e no g2 de 353 mg/dl. Quarenta e sete por cento dos pacientes do gl e 80% do g2, apresentaram medidas >300 mg/dl. As diferenças obtidas entre os grupos neste estudo foram significantes. Conclusão- Considerando o nível de risco epidemiológico de 300 mg/dl, nossos resultados sugerem que o fibrinogênio é um fator de risco independente para AVC aterotrombótico, especialmente naqueles com alteração de fluxo carotídeo.

Palavras chave: doença cerebrovascular, fibrinogênio, fator de risco, ultra-sonografia carotídea.

ABSTRACT

We have studied fibrinogen levels (Clauss technique) in atherothrombotic ischemic stroke patients, in order to determine its role as a thombogenic risk factor. Twenty nine patients (20 men and 9 women) between 25 and 79 years old were studied; they all have had a atherothrombotic stroke. They were classified into two groups according to the result of their carotid doppler ultrasonography: g1 - without carotid flow reduction (n=l 9) and g2 - with carotid flow reduction (n=10). The fibrinogen mean value was 269mg/dl in gl and 353 mg/dl in g2. There were 47% of patients in gl and 80% of patients in g2 who presented levels >300 mg/dl. The proportions of the groups were significantly different (p<0,05). Considering the epidemiological value of 300 mg/dl, we conclude that the fibrinogen can be an independent risk factor for ischemic atherothrombotic stroke, specially in those whose carotid flow is reduced.

Key words: stroke, cerebrovascular disease, fibrinogen, risk factor, carotid ultrasonography.

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Agradecimentos - Agradecemos ao Prof. Dr. Neil Ferreira Novo e à Profa. Dra. Yara Juliano pela orientação da análise estatística.

Aceite: 7-julho-1997.

Estudo realizado na Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP).

Dra. Marcia Maiumi Fukujima - Universidade Federal de São Paulo, Disciplina de Neurologia - Rua Botucatu 740 - 04023-900 São Paulo SP - Brasil. Fax 011 575 5240. E-mail: Maiumi@sti.com.br ou maiumi@sun-nepi.epm.br

1. Cook NS, Ubben D. Fibrinogen as a major risk in cardiovascular disease. TIPS 1990; 11: 444-451.
2. Ernst E, Matrai A, Marshall M. Blood rheology in patients with transient ischemic atacks. Stroke 1988; 19: 624-636.
3. Ernst E, Resch KL. The "fibrinogen hypothesis": is elevated plasma fibrinogen a major cardiovascular risk factor? In Woodford FP, Davignon J, Sniderman A (eds). Atherosclerosis X. Amsterdam: Elsevier, 1995:785-792.
4. Ernst E, Resch KL, Matrai A, Buhl M, Schlosser P, Paulsen HF. Impaired blood rheology: a risk factor after stroke? J Intern Med 1991;229:457-462.
5. Fletcher AP, Alkjaersig N, Davis A, Lewis M. Blood coagulation and plasma fibrinolitic enzyme system pathophysiology in stroke. Stroke 1976;7:337-348.
6. Grotta J, Ackerman R, Correia J, Fallick G, Chang J. Whole blood viscosity parameters and cerebral blood flow. Stroke 1982;13:296-301.
7. Hamsten A, Iselius L, de Faire U, Blombäck M. Genetic and cultural inheritance of plasma fibrinogen concentration. Lancet 1987;2:988-990.
8. Heinrich J, Schulte H, Balleisen L, Assmann G, van de Loo J. Predictive value of haemostatic variables in the PROCAM-study. Thromb Haemostas 1991;65:8I5.
9. Humphries SE, Cook M, Dubowitz M, Stirling Y, Meade TW. Role of genetic variation at the fibrinogen locus in determination of plasma fibrinogen concentrations. Lancet 1987,1:1452-1454.
10. Kannel WB, D'Agostinho RB, Belanger AJ. Fibrinogen, cigarette smoking, and risk of cardiovascular disease: insights from The Framingham Study. Am Heart J 1987;113:1006-1010.
11. Kannel WB, Wolf PA Castelli WP, D'Agostinho RB. Fibrinogen and risk of cardiovascular disease. JAMA 1987;258:1183-1186.
12. Mann KG. Blood coagulation: linkage between thombosis and atherosclerosis: an overview. In Woodford FP, Davignon J, Sniderman A (eds). Atherosclerosis X. Amsterdam: Elsevier, 1995:780-784.
13. Meade TW, Brozovic M, Chakrabarti RR, et al.. Haemostatic funcion and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986;2:533-537.
14. Pilgeram LO, Chee AN, von dem Bussche G. Evidence for abnormalities in clotting and thrombolysis as a risk factor for stroke. Stroke 1973;4:643-657.
15. Sadoshima S, Tanaka K. Fibrinogen and low density lipoprotein in the development of cerebral atherosclerosis. Atherosclerosis 1979;34:93-103.
16. Todd M, McDevitt E, McDowell F. Stroke and blood coagulation. Stroke 1973;4:400-405.
17. Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984;311:501-505.
18. Whisnant JP, Basford JR, Bernstein EF et al.. Special report from the National Institute of Neurological Disorders and Stroke: Classification of Cerebrovascular Disease III. Stroke 1990;21:637-676.

Datas de Publicação

Publicação nesta coleção
21 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Cook NS, Ubben D. Fibrinogen as a major risk in cardiovascular disease. TIPS 1990; 11: 444-451.

[2] 2. Ernst E, Matrai A, Marshall M. Blood rheology in patients with transient ischemic atacks. Stroke 1988; 19: 624-636.

[3] 3. Ernst E, Resch KL. The "fibrinogen hypothesis": is elevated plasma fibrinogen a major cardiovascular risk factor? In Woodford FP, Davignon J, Sniderman A (eds). Atherosclerosis X. Amsterdam: Elsevier, 1995:785-792.

[4] 4. Ernst E, Resch KL, Matrai A, Buhl M, Schlosser P, Paulsen HF. Impaired blood rheology: a risk factor after stroke? J Intern Med 1991;229:457-462.

[5] 5. Fletcher AP, Alkjaersig N, Davis A, Lewis M. Blood coagulation and plasma fibrinolitic enzyme system pathophysiology in stroke. Stroke 1976;7:337-348.

[6] 6. Grotta J, Ackerman R, Correia J, Fallick G, Chang J. Whole blood viscosity parameters and cerebral blood flow. Stroke 1982;13:296-301.

[7] 7. Hamsten A, Iselius L, de Faire U, Blombäck M. Genetic and cultural inheritance of plasma fibrinogen concentration. Lancet 1987;2:988-990.

[8] 8. Heinrich J, Schulte H, Balleisen L, Assmann G, van de Loo J. Predictive value of haemostatic variables in the PROCAM-study. Thromb Haemostas 1991;65:8I5.

[9] 9. Humphries SE, Cook M, Dubowitz M, Stirling Y, Meade TW. Role of genetic variation at the fibrinogen locus in determination of plasma fibrinogen concentrations. Lancet 1987,1:1452-1454.

[10] 10. Kannel WB, D'Agostinho RB, Belanger AJ. Fibrinogen, cigarette smoking, and risk of cardiovascular disease: insights from The Framingham Study. Am Heart J 1987;113:1006-1010.

[11] 11. Kannel WB, Wolf PA Castelli WP, D'Agostinho RB. Fibrinogen and risk of cardiovascular disease. JAMA 1987;258:1183-1186.

[12] 12. Mann KG. Blood coagulation: linkage between thombosis and atherosclerosis: an overview. In Woodford FP, Davignon J, Sniderman A (eds). Atherosclerosis X. Amsterdam: Elsevier, 1995:780-784.

[13] 13. Meade TW, Brozovic M, Chakrabarti RR, et al.. Haemostatic funcion and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1986;2:533-537.

[14] 14. Pilgeram LO, Chee AN, von dem Bussche G. Evidence for abnormalities in clotting and thrombolysis as a risk factor for stroke. Stroke 1973;4:643-657.

[15] 15. Sadoshima S, Tanaka K. Fibrinogen and low density lipoprotein in the development of cerebral atherosclerosis. Atherosclerosis 1979;34:93-103.

[16] 16. Todd M, McDevitt E, McDowell F. Stroke and blood coagulation. Stroke 1973;4:400-405.

[17] 17. Wilhelmsen L, Svardsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med 1984;311:501-505.

[18] 18. Whisnant JP, Basford JR, Bernstein EF et al.. Special report from the National Institute of Neurological Disorders and Stroke: Classification of Cerebrovascular Disease III. Stroke 1990;21:637-676.