Background: Only a few non-recent studies assessed the importance of hematocrit (HCT) in patients with ischemic stroke. We evaluated how HCT might affect early mortality after stroke. Methods: We investigated all first-ever ischemic strokes included in the population-based L’Aquila registry. 3,481 patients according to HCT (%) values were included into four categories (≤40, 41–45, 46–50, and >50). Results: There were more men than women with HCT >50 (6.6 vs. 2.8%; p < 0.0001) and more women than men with HCT ≤40 (48.5 vs. 37.9%; p < 0.0001). Proportions of chronic atrial fibrillation (p = 0.0053) increased in women from the lower to the higher HCT categories. 7- and 28-day case-fatality rates were similar in men and women in the lower HCT categories but higher in women than in men in the higher categories. At the 28-day Kaplan-Meier analysis, men had similar survivals in the different categories while women with HCT >50 showed the worst survival (p < 0.0001). At the multivariate Cox regression analysis HCT 46–50 and >50 was an independent predictor of mortality in women within 28 days. Conclusion: High HCT might represent in women a previously underestimated independent predictor of mortality after ischemic stroke. Consideration of HCT in future stroke trials would be useful for ameliorating stroke care, especially in women.

Keywords:
Ischemic stroke, Hematocrit, Mortality
1.
Kannel WB, Gordon T, Wolf PA, McNamara P: Hemoglobin and the risk of cerebral infarction: the Framingham Study. Stroke 1972;3:409–420.
2.
Tohgi H, Yamanouchi H, Murakami M, Kameyama M: Importance of the hematocrit as a risk factor in cerebral infarction. Stroke 1978;9:369–374.
3.
Gagnon DR, Zhang TJ, Brand FN, Kannel WB: Hematocrit and the risk of cardiovascular disease – the Framingham study: a 34-year follow-up. Am Heart J 1994;127:674–682.
4.
Wannamethee G, Perry IJ, Shaper AG: Haematocrit, hypertension and risk of stroke. J Intern Med 1994;235:163–168.
5.
Diamond PT, Gale SD, Evans BA: Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. Arch Phys Med Rehabil 2003;84:964–967.
6.
Italian Acute Stroke Study Group: Haemodilution in acute stroke: results of the Italian haemodilution trial: Lancet 1988;1:318–321.
7.
Matthews WB, Oxbury JM, Grainger KM, Greenhall RC: A blind controlled trial of dextran 40 in the treatment of ischaemic stroke. Brain 1976;99:193–206.
8.
Ozaita G, Calandre L, Peinado E, Rodríguez-Antigüedad A, Bermelo F: Hematocrit and clinical outcome in acute cerebral infarction. Stroke 1987;18:1166–1168.
9.
Feigin VL, Lawes CMM, Bennett DA, Anderson CS: Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurology 2003;2:43–53.
10.
Carolei A, Marini C, Di Napoli M, Di Gianfilippo G, Santalucia P, Baldassarre M, De Matteis G, di Orio F: High stroke incidence in the prospective community-based L’Aquila Registry (1994–1998): First year’s results. Stroke 1997;28:2500–2506.
11.
World Health Organization: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, 9th Revision. Geneva, WHO, 1977, vol 1.
12.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
13.
Perez-Trepichio AD, Furlan AJ, Little JR, Jones SC: Hydroxyethyl starch 200/0.5 reduces infarct volume after embolic stroke in rats. Stroke 1992;23:1782–1790.
14.
Yanaka K, Camarata PJ, Spellman SR, McDonald DE, Heros RC: Optimal timing of hemodilution for brain protection in a canine model of focal cerebral ischemia. Stroke 1996;27:906–912.
15.
Allport LE, Parsons MW, Butcher KS, MacGregor L, Desmond PM, Tress BM, Davis SM: Elevated hematocrit is associated with reduced reperfusion and tissue survival in acute stroke. Neurology 2005;6:1382–1387.
16.
Koenig W, Ernst E: The possible role of hemorheology in atherothrombogenesis. Atherosclerosis 1992;94:93–107.
© 2007 S. Karger AG, Basel
2007
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.