Fibrinolytic activity after subarachnoid haemorrhage and the effect of tranexamic acid.
Seventy-four patients with recent subarachnoid haemorrhage were randomly allocated to placebo or tranexamic acid treatment. Fibrinolytic activity in the blood and cerebrospinal fluid was assessed before treatment, one week later and two weeks later. The natural history of fibrinolysis following subarachnoid haemorrhage was obtained from analysis of the placebo group. Following subarachnoid haemorrhage, fibrin degradation products and plasminogen activity in the cerebrospinal fluid were elevated. Subsequently, fibrin degradation products in the cerebrospinal fluid fell progressively over the following 2 weeks. Changes in cerebrospinal fluid plasminogen activity correlated with those of blood plasminogen activity. Complications such as rebleeding, hydrocephalus or cerebral thrombosis could not be predicted from analysis of fibrinolytic activity. Tranexamic acid treatment resulted in a reduction in cerebrospinal fluid and blood plasminogen activity. The relevance of fibrinolysis in cerebrospinal fluid and blood to the management of subarachnoid haemorrhage is discussed.
Midland Centre for Neurosurgery and Neurology, Smethwick, Warley, U.K.
S A
SA
Tsementzis
W P
WP
Honan
S
S
Nightingale
E R
ER
Hitchcock
C H
CH
Meyer
D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000134:cerebrospinal fluid*; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010958:Plasminogen / Q000134:cerebrospinal fluid*; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000378:metabolism*; D014148:Tranexamic Acid / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D003509:Cyclohexanecarboxylic Acids; D014148:Tranexamic Acid; D005340:Fibrinogen; D010958:Plasminogen