title: Early fibrinogen degradation coagulopathy is predictive of parenchymal hematomas in cerebral rt-PA thrombolysis: a study of 157 cases.
abstract: BACKGROUND
  Little is known about the coagulation factors as predictors of cerebral bleeding in rt-PA thrombolysis. The aim of this study was to determine what early coagulation parameters could predict early hemorrhagic lesions.
  
  
  METHODS
  Consecutive patients were included in the Lyon rt-PA protocol. Early hematomas (within 24 hours), diagnosed on an anatomoradiological basis (symptomatic and not symptomatic) were considered for the study. Fibrinogen and fibrin(ogen) degradation products (FDP) were assessed at entry and at 2 and 24 hours after the beginning of thrombolysis.
  
  
  RESULTS
  Of 157 patients, 11 had early parenchymal hematomas (7%), 31 had early hemorrhagic infarcts (19.7%), and 115 had no bleeding (73.2%). In logistic regression, FDP at 2 hours was the single predictor of parenchymal hematomas (OR: 2.5; CI: 1.09 to 5.8), whereas an increase of FDP >200 mg/L multiplied the odds of parenchymal hematoma by 4.95 (IC: 1.09 to 22.4). Early parenchymal hematomas were indicative of a poor prognosis at 3 months (P=0.001).
  
  
  CONCLUSIONS
  Early parenchymal hematomas appear as both "malignant" and exclusively related to an explosive increase of FDP at 2 hours, ie, an early fibrinogen degradation coagulopathy (EFDC). All patients scheduled to rt-PA thrombolysis should have an assay of FDP 2 hours after the beginning of thrombolysis: patients with an established EFDC (FDP >200 mg/L) should be monitored specifically, with no antithrombotic drug during the first 72 hours. Patients with FDP >100 mg should share the same monitoring.
authors.affiliation: Cerebrovascular Unit, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France. paul.trouillas@chu-lyon.fr
authors.forename: Paul
authors.initials: P
authors.lastname: Trouillas
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Fréderic
authors.initials: F
authors.lastname: Philippeau
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: Jerome
authors.initials: J
authors.lastname: Honnorat
authors.forename: Micel
authors.initials: M
authors.lastname: Hanss
authors.forename: Patrick
authors.initials: P
authors.lastname: Ffrench
authors.forename: Patrice
authors.initials: P
authors.lastname: Adeleine
authors.forename: Marc
authors.initials: M
authors.lastname: Dechavanne
mesh_terms: D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D015331:Cohort Studies; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006406:Hematoma / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D011379:Prognosis; D020521:Stroke / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator