Coexistence of High Fibrinogen and Low High-density Lipoprotein Cholesterol Levels Predicts Recurrent Cerebral Venous Thrombosis
Xin Ma1, Xun-Ming Ji2, Paul Fu3, Yu-Chuan Ding3, Qiang Xue4, Yue Huang5
1 Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
2 Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
3 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48202, USA
4 Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053; Department of Medical Care for Cadres, Beijing Jishuitan Hospital, Beijing 100035, China
5 Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100053; Department of Neurology, Beijing Bo Ai Hospital, Beijing 100068, China
Department of Neurology, Xuan Wu Hospital, Capital Medical University, 45 Changchun Street, Beijing 100053
Source of Support: None, Conflict of Interest: None
Background: Cerebral venous thrombosis (CVT) may lead to serious neurological disorders; however, little is known about the risk factors for recurrent CVT. Our aim was to determine the association between elevated fibrinogen and decreased high-density lipoprotein cholesterol (HDL-C) levels with recurrent CVT.
Methods: This retrospective cohort study included participants if they had a first episode of objectively defined CVT and were admitted to Xuan Wu Hospital, Capital Medical University from August 2005 to September 2009. Demographic and clinical variables were collected, as well as laboratory parameters, including plasma fibrinogen and HDL-C. Patients with CVT were followed for recurrent symptomatic CVT. Follow-up was through the end of September 2010. Potential predictors of recurrence were analyzed using Cox survival analysis.
Results: At the end of the follow-up, 95 patients were eligible for the study. Twelve of 95 patients (12.6%) had recurred CVT. The median time of recurrence was 7 months (range: 1-39 months). Eight of these 12 (66.7%) experienced recurrence within the first 12 months after their initial CVT. The recurrence rate of CVT was 2.76 per 100 patient-years. Multivariate Cox regression analysis demonstrated that the coexistence of high fibrinogen (>4.00 g/L) and low HDL-C (<1.08 mmol/L) levels at baseline was the only independent predictor for recurrent CVT (hazard ratio: 4.69; 95% confidence interval: 1.10-20.11; P < 0.05). Of the twelve patients with recurrent CVT in our study, 7 (58.3%) had high fibrinogen plus low HDL-C levels. All 7 of these patients took warfarin for 3-12 months, and 6 of 7 had recurrent CVT after the discontinuation of anticoagulant treatment.
Conclusions: Concomitant high fibrinogen and low HDL-C levels may be associated with recurrence of CVT. The effect of potential risk factors related to atherothrombosis on recurrent CVT should be closely monitored.