Fibrinogen albumin ratio and ischemic stroke during venoarterial extracorporeal membrane oxygenation

Prakash Acharya, William A. Jakobleff, Stephen J. Forest, Thiru Chinnadurai, Nicolas Mellas, Snehal R. Patel, Jorge R. Kizer, Henny H. Billett, Daniel J. Goldstein, Ulrich P. Jorde, Omar Saeed

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Fibrinogen is a clotting factor and a major determinant of platelet aggregation. Albumin, on the other hand, inhibits platelet function and thrombus formation. Taken together, an elevated fibrinogen albumin ratio (FAR) has been described as a marker of disease severity during prothrombotic conditions. We evaluated the association of FAR and ischemic stroke during venoarterial extracorporeal membrane oxygenation (VA ECMO) support. A single center, retrospective study was performed including all adult patients placed on VA ECMO. FAR was calculated from fibrinogen and albumin measurements in the first 24 hours of VA-ECMO initiation. Patients were categorized into high (≥125) and low (<125) FAR groups and the risk of eventual ischemic stroke was determined. There were 201 patients who underwent VA ECMO placement and 157 had a FAR. They were 56 ± 14 years old and 66 (42%) had a high FAR. Patients with a high FAR had lower survival free from an ischemic stroke during VA ECMO (log rank p < 0.001; adjusted hazard ratio 5.51; 95% CI: 1.8–16.5). In tertile analysis, the level of FAR was associated with an incrementally higher likelihood of eventual ischemic stroke (log rank p = 0.004). Those with a high FAR had greater mean platelet volume (10.8[10.4–12] vs. 10.5[10.2–11.9]fl, p = 0.004). An elevated FAR during the first 24 hours of VA ECMO placement is associated with a greater risk of a subsequent ischemic stroke. Our findings suggest that assessment of FAR soon after VA ECMO placement may assist with early stratification of patients at risk for an ischemic stroke.

Original languageEnglish (US)
Pages (from-to)277-282
Number of pages6
JournalASAIO Journal
StatePublished - Mar 1 2020


  • Albumin
  • Fibrinogen
  • Stroke

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering


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