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NEUROLOGY 2005;65:1382-1387
© 2005 American Academy of Neurology

Elevated hematocrit is associated with reduced reperfusion and tissue survival in acute stroke

L. E. Allport, FRACP, M. W. Parsons, FRACP, PhD, K. S. Butcher, FRCP(C), FRACP, PhD, L. MacGregor, MBBS, MMedSc, P. M. Desmond, MD, FRACR, B. M. Tress, MD, FRACR and S. M. Davis, MD, FRCP, FRACP

From the Departments of Neurology (Drs. Allport, Parsons, Butcher, and Davis), Clinical Epidemiology (Dr. MacGregor), and Radiology (Drs. Desmond and Tress), Royal Melbourne Hospital and University of Melbourne, Parkville Victoria, Australia.

Address correspondence and reprint requests to Dr. S. Davis, Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; e-mail: stephen.davis{at}mh.org.au

Background: Elevated hematocrit (Hct) contributes to blood viscosity and has an adverse effect in acute stroke. The authors investigated the influence of Hct on tissue fate using serial MRI in acute stroke patients.

Methods: The effects of Hct on reperfusion, penumbral salvage, and infarct expansion in 64 patients presenting within 24 hours of stroke onset were measured. MRI was performed at baseline (<24 hours), days 3 to 5, and 90 days from stroke onset.

Results: Median Hct was 42% with a bimodal distribution. There was a strong inverse relationship between Hct and reperfusion (Spearman {rho} = –0.74, p < 0.0001). The odds of major reperfusion (>50% resolution of the baseline perfusion-weighted imaging deficit) were significantly lower with increasing Hct (odds ratio [OR] = 0.53; 95% CI = 0.97 to 1.00), independent of age, perfusion, and diffusion lesion volumes and recombinant tissue plasminogen activator (rtPA) administration. There was a trend toward reduced penumbral salvage at days 3 to 5 with increasing Hct (p = 0.06, 95% CI = –4.76 to 0.14). An increasing Hct was a significant predictor of infarct growth (OR = 1.26, 95% CI = 1.00 to 1.59), independent of baseline perfusion and diffusion volumes and glucose. The effect of Hct on reperfusion and infarct expansion was similar irrespective of rtPA administration (p = 0.31) and independent of smoking status.

Conclusions: Higher hematocrit (Hct) values have a significant independent association with reduced reperfusion and greater infarct size after ischemic stroke. An elevated Hct may also be a potential physiologic determinant of reduced penumbral salvage.

Supported by an Australian Postgraduate Award Scholarship (University of Melbourne) and the Royal Melbourne Hospital Neuroscience Foundation (L.E.A.).

Disclosure: The authors report no conflicts of interest.

Received April 1, 2005. Accepted in final form July 19, 2005.


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