Assessment of the haemostatic system in patients surgically treated for ruptured cerebral aneurysm.
OBJECTIVE
The aim of the study was to evaluate selected markers of thrombin generation and subsequent fibrinolysis in patients with aneurysmal subarachnoid haemorrhage (SAH) and to assess the relationship between thrombin generation/fibrinolysis and clinical course and outcome.


METHODS
This prospective study included 72 patients after aneurysmal SAH who underwent surgery within 72 hours after onset of symptoms. The results were compared with 84 control patients without SAH. Selected markers of thrombin generation (thrombin-antithrombin complexes, TAT), fibrinolysis (D-dimer) and fibrinogen level were examined in blood just after admission and on day 7 after surgery. The relationship between levels of those markers and selected clinical and radiological data, and outcome at 3-6 months after surgery, were assessed.


RESULTS
On admission, patients with SAH had higher levels of TAT (p<0.001), D-dimer (p=0.048), and fibrinogen than the control group (p<0.001). Also, patients with severe bleeding demonstrated higher TAT (p<0.001) and D-dimer (p=0.04) levels. The admission level of TAT (higher than 24 g/l; odds ratio = 10.8) and the elevated blood fibrinogen level (odds ratio = 1.2) showed a strong correlation with mortality. Furthermore, a level of TAT higher than 24 g/l (odds ratio = 9.98) and the level of fibrinogen (odds ratio = 1.3) strongly correlated with poor outcome. There was no significant correlation between markers of coagulation on the 7th day after surgery for SAH and the outcome.


CONCLUSIONS
Activation of blood coagulation as well as the fibrinolytic system occurred early in the course of SAH. Such activation was associated with poor clinical status of patients on admission, greater amount of subarachnoid blood, and poor clinical outcome. Thus, blood levels of TAT and fibrinogen are independent factors associated with mortality and morbidity after aneurysmal SAH.
Morga
Rafał
R
Klinika Neurochirurgii Instytut Neurologii Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków. rafalmor@wp.pl
Czepko
Ryszard
R
Dembińska-Kieć
Aldona
A
Danilewicz
Benedykt
B
D000368:Aged; D017542:Aneurysm, Ruptured / Q000097:blood* / Q000601:surgery; D000991:Antithrombins / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011044:Poland; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000601:surgery; D013917:Thrombin / Q000378:metabolism
D000991:Antithrombins; D015415:Biomarkers; D013917:Thrombin