Hemostatic activation in spontaneous intracerebral hemorrhage

Background and Purpose-There is no in-depth information available on the ch anges in hemostatic systems in patients in the acute phase of spontaneous i ntracerebral hemorrhage (ICH). This study was conducted to assess the relat ionships between the changes in hemostatic systems and clinical parameters in patients in acute-phase ICH. Methods-The records of 358 patients admitted within 6 hours of onset of ICH were reviewed to examine the relationships between changes in hemostatic s ystems and computed tomographic findings and clinical parameters. Results-The white blood cell counts and the levels of thrombin-antithrombin complex, plasmin-antiplasmin complex, and D-dimer in patients with intrave ntricular extension (IVE) or subarachnoid hemorrhage (SAH) were significant ly (P<0.05) higher than those in patients without IVE or SAH. Most of the h emostatic system parameters in patients without IVE or SAH showed no signif icant differences compared with normal subjects. Multiple linear regression analysis revealed that the levels of thrombin-antithrombin complex signifi cantly increased with an increase in the amount of SAH (P<0.001) and IVE (P <0.001). The levels of thrombin-antithrombin complex were not significantly associated with the volume of intraparenchymal hematoma. The level of the complex, however, was significantly (P<0.001) and independently associated with the presence of IVE or SAH (multiple logistic regression analysis). Conclusions-The systemic activation of hemostatic systems in ICH patients s eems to take place only when blood reaches the subarachnoid space. The intr aparenchymal hematoma itself seems unlikely to activate hemostatic systems in peripheral blood, although the hematoma is expected to cause local activ ation of hemostatic systems.