THROMBIN ACTIVITY IN CSP AFTER SAH IS CORRELATED WITH THE DEGREE OF SAH, THE PERSISTENCE OF SUBARACHNOID CLOT AND THE DEVELOPMENT OF VASOSPASM

We previously reported that the coagulation system in cerebrospinal fl uid (CSF) is strongly activated in the early stage of a subarachnoid h aemorrhage (SAH). We evaluated the relationship among thrombin activit y, degree of SAH, amount of clearance of SAH, and vasospasm. The CSF l evels of fibrinopeptide A (FPA) were measured by radio-immunoassay in 36 SAH patients, who were diagnosed by computerized tomography (CT) wi thin 12 hours and on whom surgery was performed within 48 hours. Clear ance of SAH (%) was evaluated as the size of the clot in the basal cis tern visualized between the initial and postoperative Cf. The mean lev el of FPA. in the patients of Group 3 (Fisher's CT classification) (18 2.2 ng/ml) was significantly higher than those in the patients of Grou p 2 (36.2 ng/ml). There was a significant difference in the mean level of FPA between patients with (47.6 ng/ml) and without infarction (408 .3 ng/ml). In 18 of the 27 patients of Group 3 for whom the clearance of the SAH was determined, the patients showing a lower clearance rate (<50%) of SAH demonstrated a significantly higher rate of infarction and a significantly higher level of FPA (466.6 ng/ml) than did the pat ients with a higher clearance rate (>50%) of SAH (79.2 ng/ml). These r esults suggest that, the thrombin activity in CSF is correlated with t he degree of SAH, the persistence of subarachnoid clot and the develop ment of vasospasm.