Hematocrit and Stroke: A Forgotten and Neglected Link?

Stavropoulos, Konstantinos; Imprialos, Κonstantinos; Bouloukou, Sofia; Boutari, Chrysoula; Doumas, Michael

doi:10.1055/s-0037-1602663

Cited by 17 publications

(20 citation statements)

References 79 publications

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“…This is probably associated with the increase in viscosity. 27 In our study, it was found statistically significant that haemoglobin, haematocrit and RBC values were lower in the stroke group compared with the non-stroke group (P < .001). In the literature, this situation was found to be associated with a long hospitalisation 28 ; however, it was not associated with mortality and stroke severity.…”

Section: Discussionsupporting

confidence: 46%

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

Kunt

Yiğitaslan

2021

Int J Clin Pract

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Aims This study aimed to examine the haemogram parameters, including the neutrophil/lymphocyte ratio (NLR), which is fast, easy and practical to determine, in stroke patients who present with more physiological stress and inflammation and compare them with patients presenting other neurological diseases. Methods The demographic, laboratory and imaging features of all patients who were admitted to the neurology clinic within a three‐year period and met the study criteria were retrospectively analysed. A haemogram from peripheral venous blood samples was taken at the time of admission, and its parameters was calculated. Results A total of 3152 patients, 1604 of whom were women (50.9%), with a mean age of 66.1 ± 14 (18‐100) years who were hospitalised in the neurology clinic from 1 January 2015 to 1 January 2018, comprised the study's sample. Mean age, mean leukocyte‐neutrophil count and NLR were significantly higher in stroke patients than in those without stroke (P < .001, P < .001 and P < .001, respectively), but mean red blood cell, platelet and lymphocyte counts, and haemoglobin and haematocrit values were found to be significantly lower (P < .001, P < .001, P < .001, P < .001 and P < .001, respectively). When the haemogram parameters were compared according to stroke type, red blood cell, haemoglobin, haematocrit and NLR values in patients with haemorrhagic stroke (P = .019, P = .002, P = .002 and P = .001, respectively) and platelet and lymphocyte values in ischaemic stroke patients were found to be significantly higher (P = .002 and P < .001, respectively). Conclusion In this study, significant data obtained by comparing the haemogram parameters of those with stroke and other neurological diseases are presented. All neurological diseases, especially acute stroke and its types, should be examined in future prospective, randomised and controlled studies with all haemogram parameters, especially the NLR. However, it should be noted that haematological parameters are more useful for group studies rather than determining the diagnosis of an individual patient.

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Section: Discussionsupporting

confidence: 46%

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

Kunt

Yiğitaslan

2021

Int J Clin Pract

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“…This is the postulated most important protective factor when reducing the size of a stroke and when improving recovery after an ischemic episode at high altitude ( Yang et al, 2010 ; Dunn et al, 2012 ; Hayakawa et al, 2017 ; Belayev et al, 2018 ). Nevertheless, above this point, high hematocrit levels due to a significant polycythemia causing thicker blood overcome this protective factor, reducing blood flow, and causing stasis as well as thrombogenesis ( Tohgi et al, 1978 ; Meifang et al, 2000 ; Stavropoulos et al, 2017 ; Warny et al, 2019 ). Although no data from human studies are available, our results support the plausible relationship of a “protective window” that lays between 2,000 and 3,500 m of elevation, we suggest that anything below this point progressively loses the hypothesized protective effect that causes higher stroke incidence.…”

Section: Discussionmentioning

confidence: 99%

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

et al. 2021

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Introduction: Worldwide, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analyses suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates.Methods: An ecological analysis of all stroke hospital admissions, mortality rates, and disability-adjusted life years in Ecuador was performed from 2001 to 2017. The cases and population at risk were categorized in low (<1,500 m), moderate (1,500–2,500 m), high (2,500–3,500 m), and very high altitude (3,500–5,500 m) according to the place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated.Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.

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“…Some authors reported this phenomenon as a potentially negative effect, while others have simply described the finding without comment [ 16 – 19 ]. The relationship between hematocrit, diabetes mellitus and cardiovascular diseases is very complex [ 20 ]. Increased hematocrit level seems to have negative impact on glucose metabolism, that is, an increased risk of developing diabetes or prediabetes [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Empagliflozin influences blood viscosity and wall shear stress in subjects with type 2 diabetes mellitus compared with incretin-based therapy

Irace

Casciaro

Scavelli

et al. 2018

Cardiovasc Diabetol

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BackgroundCardiovascular protection following empagliflozin therapy is not entirely attributable to the glucose lowering effect. Increased hematocrit might influence the shear stress that is the main force acting on the endothelium, regulating its anti-atherogenic function.ObjectiveWe designed the study with the aim of investigating the effect of empagliflozin on blood viscosity and shear stress in the carotid arteries. A secondary endpoint was the effect of empagliflozin on carotid artery wall thickness.MethodsThe study was a non-randomized, open, prospective cohort study including 35 type 2 diabetic outpatients who were offered empagliflozin or incretin-based therapy (7 liraglutide, 8 sitagliptin) in combination with insulin and metformin. Blood viscosity, shear stress and carotid wall thickness were measured at baseline and at 1 and 3 months of treatment. Blood viscosity was measured with a viscometer, and shear stress was calculated using a validated formula. Intima-media thickness (IMT) of the carotid artery was detected by ultrasound and was measured with dedicated software.ResultsBlood viscosity (4.87 ± 0.57 vs 5.32 ± 0.66 cP, p < 0.02) and shear stress significantly increased in the Empagliflozin group while no change was detected in the Control group (4.66 ± 0.56 vs 4.98 ± 0.73 cP, p = NS). IMT significantly decreased in the Empagliflozin group after 1 and 3 months (baseline: 831 ± 156, 1-month 793 ± 150, 3-month 766 ± 127 μm; p < 0.0001), while in the liraglutide group, IMT significantly decreased only after 3 months (baseline 879 ± 120; 1-month 861 ± 163; 3-month 802 ± 114 μm; p < 0.001). In the sitagliptin group, IMT remained almost unchanged (baseline 901 ± 135; 1-month 902 ± 129; 3-month 880 ± 140 μm; p = NS).ConclusionsThis study is the first to describe a direct effect of empagliflozin on blood viscosity and wall shear stress. Furthermore, IMT was markedly reduced early on in the Empagliflozin group.

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Hematocrit and Stroke: A Forgotten and Neglected Link?

Cited by 17 publications

References 79 publications

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

Empagliflozin influences blood viscosity and wall shear stress in subjects with type 2 diabetes mellitus compared with incretin-based therapy

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