HEMOSTASIS AND FIBRINOLYSIS ACTIVATION AFTER SUBARACHNOID HEMORRHAGE

The authors assessed hemostasis and fibrinolysis serially: on admissio n and on the Ist and 7th days after surgery for subarachnoid hemorrhag e (SAH), examining the complications of aneurysm rupture and its surgi cal repair. Of 32 patients, 25 with SAH were compared with seven contr ol patients who underwent surgery for an unruptured intracranial aneur ysm. On admission, patients with SAH had higher thrombin-antithrombin III complex (TAT) levels (13.3 +/- 3.8 vs. 3.8 +/- 0.6 ng/ml, p = 0.01 ), fibrin degradation product, D-dimer levels (1310 +/- 220 vs. 556 +/ - 89 ng/ml, p = 0.0001), and leukocyte counts (14.6 +/- 0.7 vs. 10.6 /- 1.8 X 10(9) cells/L, p < 0.05) than did control patients. Postopera tive D-dimer values (p = 0.007) remained higher in the SAH group. Furt hermore, admission D-dimer levels were higher in the patients in poor clinical condition than in those in good condition (2017 +/- 377 vs. 9 34 +/- 208 ng/ml, p = 0.007), and D-dimer levels were associated with the outcome at 3 months after admission. Additionally, thrombin genera tion and fibrinolytic markers measured on admission were related to cl inical grade, amount of subarachnoid blood seen on computerized tomogr aphy (CT) scanning, and patient fatality. Patients with hypodense lesi ons verified on follow-up CT scanning or with persistent neurological deficits at 3 months had higher prothrombin fragments 1 and 2, TAT, D- dimer, and plasminogen activator inhibitor-1 values on the Ist day pos toperatively than did patients without such lesions. Tn short, in pati ents with SAH, activation of coagulation and fibrinolysis was strongly associated with clinical state, patient fatality, and outcome at 3 mo nths, and postoperatively this activation correlated with the developm ent of brain infarction.