Early fibrinogen degradation coagulopathy is predictive of parenchymal hematomas in cerebral rt-PA thrombolysis: a study of 157 cases.
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.
Trouillas
Paul
P
Cerebrovascular Unit, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France. paul.trouillas@chu-lyon.fr
Derex
Laurent
L
Philippeau
Fréderic
F
Nighoghossian
Norbert
N
Honnorat
Jerome
J
Hanss
Micel
M
Ffrench
Patrick
P
Adeleine
Patrice
P
Dechavanne
Marc
M
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
D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator