title: Coagulative and fibrinolytic activation in cerebrospinal fluid and plasma after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Intrathecal fibrinolytic therapy has been used as one of the anticerebral vasospasm (VS) preventative therapies in patients with subarachnoid hemorrhage (SAH). However, the changes in coagulation and fibrinolysis in the blood and cerebrospinal fluid (CSF) after SAH remain unknown.
  
  
  METHODS
  Fifty patients with SAH caused by ruptured cerebral aneurysms were studied postoperatively to detect the serial changes of the thrombin-antithrombin III complex, active plasminogen activator inhibitor (PAI)-1, and tissue plasminogen activator (tPA)-PAI complex (tPA-PAI) activities in the plasma and CSF collected from cisternal drainage catheters.
  
  
  RESULTS
  The CSF levels of all parameters and plasma PAI-1 levels were significantly higher in patients with severe SAH than in those with mild SAH. There was no relationship between the CSF and plasma levels of these parameters (except the CSF levels of tPA-PAI) and the initial neurological statuses. The CSF PAI-1 levels increased to greater than 20 ng/ml near the time of the occurrence of cerebral VS, whereas they remained below 20 ng/ml in patients without VS. The CSF tPA-PAI levels showed the highest peak near the time of VS remission. The CSF PAI-1 and tPA-PAI levels were significantly lower in patients with good outcomes than in those with poor outcomes.
  
  
  CONCLUSIONS
  Both the coagulative and fibrinolytic systems were activated in the CSF and plasma after SAH in correlating to the amount of SAH clot. The intrathecal administration of fibrinolytic agents should be started early after surgery, before CSF PAI-1 levels increase, for patients with severe SAH. Patients with CSF PAI-1 levels greater than 20 ng/ml experienced high incidence of VS and poor outcomes.
authors.affiliation: Department of Neurosurgery, Kanazawa University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ikeda
authors.forename: H
authors.initials: H
authors.lastname: Asakura
authors.forename: K
authors.initials: K
authors.lastname: Futami
authors.forename: J
authors.initials: J
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D001921:Brain / Q000601:surgery; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications; D002546:Ischemic Attack, Transient / Q000134:cerebrospinal fluid / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000134:cerebrospinal fluid; D011184:Postoperative Period; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000134:cerebrospinal fluid; D016896:Treatment Outcome
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D010959:Tissue Plasminogen Activator