SERIAL CHANGES OF HEMOSTASIS IN ANEURYSMAL SUBARACHNOID HEMORRHAGE WITH SPECIAL REFERENCE TO DELAYED ISCHEMIC NEUROLOGICAL DEFICITS

This study was undertaken to elucidate comprehensively the serial chan ges occurring in hemostatic systems after aneurysmal subarachnoid hemo rrhage (SAH) and thereby to ascertain whether the examination of the i ntegrity of these systems is helpful in predicting delayed ischemic ne urological deficits (DINDs). The authors examined 117 patients admit t ed to the hospital within 24 hours after onset of SAH. Blood samples w ere collected from each patient on Days 0 (at admission), 3, 6, 14, an d 30. A number of hemostatic parameters were examined in these samples , and the relationships between their changes and DINDs were assessed. Eighteen (15.4%) of the patients exhibited DINDs, and their frequency increased as the severity of subarachnoid clotting increased. Also, t he frequency of DINDs was significantly higher in the patients with hy drocephalus on initial computerized tomography (CT) scans than in thos e without hydrocephalus. Regarding the hemostatic parameters at admiss ion, there was no significant difference between the patients with and without DINDs. On Day 3, however, the fibrinogen and D-dimer levels w ere higher in the patients with than in those without DINDs. The fibri nogen and thrombin-antithrombin complex levels on Day 6 and the D-dime r level on Day 14 in the patients with DINDs were higher than the corr esponding levels in those without DINDs. Multivariate analyses reveale d that the following variables (in order of importance) were independe nt predictors of DINDs: the levels of D-dimer on Day 3, fibrinogen on Day 6, and the presence of hydrocephalus on admission. These data indi cate that the levels of hemostatic parameters in concert with the CT f indings may enable us to predict the appearance of DINDs.