Evaluation of the prognostic value of coagulation function and cerebral hemodynamic changes in acute ischemic stroke patients with rheumatoid arthritis.

Abstract

To explore the relationship between early coagulation changes, cerebral hemodynamics, and neurological prognosis in acute ischemic stroke (AIS) patients with rheumatoid arthritis (RA). Seventy-two AIS patients with RA were included. Coagulation markers (PT, APTT, FIB) and transcranial Doppler ultrasound (TCD) assessments of middle cerebral artery (MCA) mean velocity (Vm) and pulsatility index (PI) were measured at baseline and after 14 days of treatment. Prognosis was evaluated using the modified Rankin Scale (mRS) at 3 months, dividing patients into good (mRS ≤ 2) and poor prognosis (mRS > 3) groups. Multivariate logistic regression and ROC analysis assessed the predictive value of coagulation and hemodynamic changes for adverse outcomes. After 14 days, APTT and MCA (PI) increased, while FIB decreased in both groups (P < 0.05). The good prognosis group had higher MCA Vm and lower FIB at baseline (P < 0.05). Independent risk factors for poor prognosis included diabetes, NIHSS score ≥ 8, FIB, and MCA (Vm, PI) (P < 0.05). ROC analysis showed combined FIB, Vm, and PI had better predictive value for poor outcomes. Early hypercoagulable state and suboptimal cerebral hemodynamics are associated with poor neurological outcomes in AIS with RA.