Fibrinolytic and factor XIII activity in subarachnoid hemorrhage

Actividad fíbrinolítica y del factor XIII en la hemorragia subaracnoidea

Fibrinolytic and factor XIII activity in subarachnoid hemorrhage

Actividad fíbrinolítica y del factor XIII en la hemorragia subaracnoidea

Luis A. Pliego; Salomon Muchnik

Alfredo Lanari Institute for Medical Research School of Medicine, University of Buenos Aires, Buenos Aires, Argentina: M.D.

ABSTRACT

The balance between fibrinolytic activity and coagulation mechanisms seems to play an important role in the rebleeding of a subarachnoid hemorrhage (SAH) due to aneurysmatic rupture. In the present paper we describe our findings in a group of patients (n10) with S AH. The plasmatic levels of fibrinogen and their degradation products (FDP), APTT, prothrombin activity and factor XIII were determined within 72 hours of initial bleeding, or of eventual rebleeding. Factor XIII activity in the first bleeding was 82.1 ±4%, while the levels of FDP were 3.8±lmg/ml. In patients presenting rebleeding (n4), Factor XIII activity was 67.3±4.5% the day it manifested, which is significantly less than the values previously observed (p<0.01), while the FDP level was 4.1±2mg/ml. The decrease of factor XIII activity suggests an important role as regards clot stability in rupture location. It is also possible to attribute a rebleeding predictive value to its activity reduction.

Key words: factor XIII activity, subarachnoid hemorrhage, aneurysm rebleeding.

RESUMEN

El balance entre la actividad fíbrinolítica y los mecanismos de la coagulación juegan un rol importante en el resangrado de una hemorragia subaracnoidea debido a ruptura aneurismástica. En el presente estúdio se describen nuestros hallazgos en un grupo de pacientes (n10) con hemorragia subaracnoidea (SAH). Los niveles plasmaticos de fibrinogeno y sus productos de degradation (FDP), la actividad de protrombina (APTT) y de factor XIII fueron determinados dentro de las 72 hs, dei sangrado inicial y ante el eventual resangrado. La actividad de factor XIII en el primer sangrado fue de 82,1±4%, mientras el nivel de FDP fue de 3,8±lmg/ml. En aquellos pacientes que resangraron (n4), la actividad de factor XIII fue de 67,3+4,5%, el dia del resangrado, el cual es significativamente menor que los valores previamente observados (p<0.01), mientras que los niveles de FDP fueron 4,1± 2mg/ml. La reduction de la actividad de factor XIII sugiere un importante rol de este en la establilidad del coágulo en el sitio de ruptura aneurismática, siendo posible atribuir un valor predicitivo a la reduction de su actividad.

Palabras-llave: actividad de factor XIII, hemorragia subaracnoidea, resangrado aneurismático.

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Aceite: 12-março-1997.

Salomon Muchnik, MD - Donato Alvarez 3150 - (1427) Buenos Aires - Argentina. FAX [phone].

• 1. Adams HP. Early management of the patient with recent aneurysmal subarachnoid hemorrhage. Stroke 1986; 17:1068-1070.
• 2. Ettinger MG. Coagulation abnormalities in subarachnoid hemorrhage. Stroke 1970;1:139-142.
• 3. Filizzolo F, D'Angelo V, Collice A. Fibrinolytic activity in blood and cerebrospinal fluid in subarachnoid hemorrhage. Eui Neurol 1978;17:43-47.
• 4. Fodstad H, Nilsson IM. Coagulation and fibinolysis in blood and cerebrospinal fluid after aneurysmal subarachnoid hemorrhage. Acta Neurochir 1981;56:25-38.
• 5. Gallhofer B, Auer IM. Spontaneous course after subarachnoid hemorrhage: evaluation of 109 patients. Acta Neurochii 1982;63:67-70.
• 6. Hijdra A, Vermeullen M, Van-Gijn J, Van-Crevel H. Rerupture of intracranial aneurysm: a clinico anatomic study. J Neurosurg 1987;67:29-33.
• 7. Kassell NF, Peerless SJ, Durwad QJ, Beck DW, Drake CS, Adams HP. Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 1982;11:337-343.
• 8. Longstreth WT Jr, Nelson LM, Koepsell TD, Van Belle G. Clinical course of spontaneous subarachnoid hemorrhage. Neurology 1993;43:712-718.
• 9. Ott E, Lechner H, Ladumer G, Aranibar A, Perry PJ, Dornauer VI. Fibrin stabilizing factor deficiency in subarachnoid hemorrhage. In Meyer JS, Lechner H, Reivich M, (eds). Cerebrovascular disease. Amsterdan: Excerpta Medica, 1977:157-158.
• 10. Ott E, Lechner H, Ladurner G, Bertha G. Fibrinolytic activity and subarachnoid hemorrhage. Neurologia et Psychiatria 1980;3:20-22.
• 11. Pliego L, Muchnik S. Factor estabilizador de la fibrina en la hemorragia subaracnoidea. Rev Neurol Argent 1988; 13:32-33.
• 12. Ramirez Lassepas M. Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage. J Neurosurg 1984;61:225-230.
• 13. Tovi D, Nilsson IM, Thulin CA. Fibrinolytic activity of the CSF after subarachnoid hemorraghe. Acta Neurol Scand 1971;49:1-9.
• 14. Vermeullen M, Lindsay KW, Murray GD, Chea F, Hijdra A, Muizelaar JP, Shannonong M, Teasdale GM, Van Crevel H, Van Gijn J. Antifibrinolityc treatment in subarachnoid hemorrhage. N Engl J Med 1984;311:432-437.

Publication Dates

• Publication in this collection
  18 Oct 2010
• Date of issue
  Sept 1997