title: Early fibrinogen degradation coagulopathy: a predictive factor of parenchymal hematomas in cerebral rt-PA thrombolysis.
abstract: OBJECTIVE
  The purpose of this study was to systematically determine the correlations between the post-thrombolytic changes of hemostasis parameters and the occurrence of early intracerebral hemorrhage (ICH).
  
  
  METHODS
  In 72 consecutive patients with cerebral infarcts treated with rt-PA, plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, factor XIII, fibrin(ogen) degradation products (FDPs) and d-Dimers were measured at baseline, 2 and 24h after thrombolysis. Correlations were studied between the hemostasis events and early (less than 24h) hemorrhagic infarcts (HIs) or parenchymatous hematomas (PH).
  
  
  RESULTS
  Of 72 patients, 6 patients (8.3%) had early PHs, 11 (15.3%) had early HIs, and 55 (76.4%) had no bleeding. Early HIs were not linked to any hemostasis parameter at any time. Univariate comparison of patients having early PHs with non-bleeding patients showed hemostasis abnormalities at 2h: high FDP (p=0.01), high Log FDP (p=0.01), low fibrinogen (p=0.01), and low Log fibrinogen (p=0.01). Logistic regression adjusted for age, NIHSS and diabetes confirmed these 2hour predictors: Log FDP (OR: 7.50; CI: 1.26 to 44.61, p=0.03), and Log fibrinogen (OR: 19.32; CI: 1.81 to 205.98, p=0.01). The decrease in fibrinogen less than 2g/L multiplies the odds of early PH by a factor 12.82.
  
  
  CONCLUSIONS
  An early fibrinogen degradation coagulopathy involving an increase of FDP and a massive consumption of circulating fibrinogen is predictive of early parenchymal hematomas, indicating the occurrence of a particularly intense lysis of circulating fibrinogen. These results, if confirmed by future studies, suggest that early assays of fibrinogen and FDP may be useful in predicting the risk of post-thrombolytic intracerebral hematoma.
authors.affiliation: From the Lyon Cerebrovascular Unit, Department of Neurology, Université Claude Bernard, Lyon, 8 Avenue Rockefeller, 69008 Lyon, France; Department of Neurology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China.
authors.forename: Xuhong
authors.initials: X
authors.lastname: Sun
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Avenue Lacassagne, 69003, Lyon F-69424, France; Université Lyon 1, Equipe d'Accueil 4129, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Berthiller
authors.affiliation: From the Lyon Cerebrovascular Unit, Department of Neurology, Université Claude Bernard, Lyon, 8 Avenue Rockefeller, 69008 Lyon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Trouillas
authors.affiliation: From the Lyon Cerebrovascular Unit, Department of Neurology, Université Claude Bernard, Lyon, 8 Avenue Rockefeller, 69008 Lyon, France. Electronic address: laurent.derex@chu-lyon.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.affiliation: From the Lyon Cerebrovascular Unit, Department of Neurology, Université Claude Bernard, Lyon, 8 Avenue Rockefeller, 69008 Lyon, France.
authors.forename: Laho
authors.initials: L
authors.lastname: Diallo
authors.affiliation: Laboratoire d'hématologie, CBPE, Hospices Civils de Lyon, Rue du Doyen Lépine, 69003 Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Hanss
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000188:drug therapy*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis*; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006406:Hematoma / Q000139:chemically induced / Q000175:diagnosis*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: 160; 175; 43; 73; Fibrinogen; Fibrinogen degradation products; Hemorrhagic infarcts; Parenchymal hematoma