Zhai et al. 1 establish that a fibrinogen increase 24 h after intravenous thrombolysis (IVT) predicts greater cerebral injury and worse outcomes. The selection of this time point is practical, yet it may overlook a critical early dynamic. Research indicates fibrinogen reaches its lowest level approximately 6 h following alteplase administration 2, 3. A rapid increase from this point, or “rebound,” could signify robust thrombin generation and a heightened pro-thrombotic state preceding clinical decline 2. Theoretically, patients experiencing early re-occlusion might demonstrate a significant fibrinogen rebound between 6 and 24 h, while their net 24-h change could appear unremarkable, potentially weakening the observed predictive signal 1. This gap can be addressed with feasible steps. First, if 6-h plasma samples were routinely collected and stored, performing a retrospective fibrinogen assay on these aliquots would allow direct comparison of its predictive value against the 24-h measure. Second, calculating the rate of fibrinogen change (the slope from 6 to 24 h) could identify patients with a rapid rebound, a pattern more closely tied to active thrombosis than a single elevated value 2. Third, integrating this dynamic measure into existing models for early neurological deterioration could clarify whether the risk is better captured by the velocity of change rather than its final magnitude. Adopting more frequent fibrinogen assessment, such as at 6-h intervals, aligns with calls for enhanced monitoring during thrombolysis to guide management 4. Identifying a rapid fibrinogen rebound early could signal the need for vigilant monitoring or prompt review of antithrombotic strategies, which are critical in the acute phase to sustain vessel patency 5. Exploring the 6-h time point, therefore, could shift the role of fibrinogen from a late prognostic indicator to an early signal with potential implications for real-time clinical decision-making. Q.F. and Y.G. designed the commentary; Q.F. drafted the manuscript; L.Y. checked numeric accuracy; all authors approved the final version. This study was supported by Xianju County People's Hospital. The authors declare no conflicts of interest. The authors have nothing to report.
Fang et al. (Fri,) studied this question.