Reduced clot-stability during the first 6 hours after aneurysmal subarachnoid haemorrhage – a prospective case-control study

• Published in: Thrombosis research Vol. 129; no. 5; pp. e229 - e232
• Main Authors: Larsen, Carl C, Sørensen, Benny, Nielsen, Jørn D, Astrup, Jens
• Format: Journal Article
• Language: English
• Published: United States 01.05.2012
• Subjects: Blood Coagulation - physiology; Case-Control Studies; Factor XIII - therapeutic use; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Prospective Studies; Subarachnoid Hemorrhage - blood; magnetic resonance imaging; tissue plasminogen activator; MRI; TAT; Factor XIII; Rebleeding; plasminogen activator inhibitor 1; AUC; plasmin-antiplasmin; TAFI; tranexamic acid; Clot stability; PAI-1; subarachnoid haemorrhage; area under the clot lysis curve; t-PA; computed tomography; Subarachnoid hemorrhage; enzyme-linked immunosorbent assays; thrombin-antithrombin; CT; thrombin-activatable fibrinolysis inhibitor; SAH; TXA; PAP; ELISA
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2012.01.016

Abstract Introduction Early rebleeding is an important cause of death and disability following aneurysmal subarachnoid haemorrhage (SAH). Recent studies have shown that 50-90% of the rebleedings occurred within the first 6 hours after the primary bleeding. The mechanism leading to rebleeding remains to be established. In the present prospective case-control study we hypothesize that patients with SAH develop a coagulopathy characterized by reduced clot stability during the early period after the initial bleeding. Methods Patients with aneurysmal SAH was studied with a dynamic clot lysis assay and markers of fibrinolysis and clot stabilizers in blood samples taken within and after 6 hours after onset of bleeding. Results were compared with blood samples from age and gender matched healthy controls. Results 36 patients were enrolled, 26 patients had blood samples collected within 6 hours after the initial bleeding whereas 10 patients had blood samples taken later than 6 hours after the initial bleeding. Patients demonstrated significantly reduced clot stability during the first 6 hours after initial bleeding. Fibrinolytic activity was increased during the first 6 hours along with the inhibitors of fibrinolysis whereas the modulators of fibrinolysis were reduced or inactivated. Conclusion During the first 6 hours after SAH patients exhibit reduced clot-stability. Probably a consequence of activated fibrinolysis in combination with reduced or inactivated factor XIII and thrombin-activable fibrinolysis inhibitor.