A study of blood coagulation and fibrinolytic system in spontaneous subarachnoid hemorrhage - Correlation with hunt-hess grade and outcome
A study of blood coagulation and fibrinolytic system in spontaneous subarachnoid hemorrhage - Correlation with hunt-hess grade and outcome
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DOI：
10.1016/s0090-3019(01)00402-5
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发表时间：
2001-04-01
影响因子：
--
通讯作者：
Demurtas, F
中科院分区：
文献类型：
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作者：
Nina, P;Schisano, G;Demurtas, F
研究背景蛛网膜下腔出血（SAH）已从不同的角度进行了研究，目的是发现可能有助于预测预后的标准。在文献中，SAH患者的凝血和纤溶障碍的发生率很高。方法对76例SAH患者的血浆止血参数进行了前瞻性研究。对凝血CPT、APTT、纤维蛋白原、凝血酶/抗凝血酶复合物（达特）和改良抗凝血酶III（MAT）和纤溶（D-二聚体）血浆系统进行了评价。血管性血友病因子（vonwillebrand factor，VWF）、APTT、纤维蛋白原（fibrinogen，FIB）均在正常范围内。高达特水平与临床结局相关，因为27例不良结局患者中有16例（59%）达特水平> 20 ngzaq/L，而38例良好结局患者中有10例（26%）。血浆D-二聚体，蛛网膜下腔血块溶解的指数，总是被发现升高。然而，在22例（73%）不良结局的患者中有16例（> 1000 mcg/mL），但在38例（26%）良好结局的患者中仅发现9例（> 1000 mcg/mL）。显著的D-二聚体升高与严重的迟发性缺血缺损（DID）密切相关。患者也进行了测试，血管性血友病因子，显示在所有cases.CONCLUSIONThe研究提供了证据，早期激活的凝血和纤溶系统以下SAH的具体增加。血浆达特的增加与临床结局平行。还观察到D-二聚体的普遍增加，并且D-二聚体水平在高范围内与DID的临床结果和不良结果相关。我们的分析显示达特、D-二聚体的血浆水平与预后之间有密切的统计学意义。当比较其他已知的预后因素，如临床酸性脑计算机断层扫描（CT）分级和结果时，也发现了类似的统计学意义。(C)2001年，Elsevier Science Inc.
BACKGROUNDSubarachnoid hemorrhage (SAH) has been studied from various standpoints with the purpose of discovering criteria that might be useful in predicting the prognosis. In the literature a high incidence of coagulative and fibrinolytic disorders has been reported in SAH patients. A prospective study was performed to evaluate hemostatic plasmatic parameters in SAH patients.METHODSHemostatic plasmatic parameters were prospectively studied in 76 patients with SAH. Both the coagulative CPT, APTT, fibrinogen, thrombin/antithrombin complex: TAT, and modified antithrombin III: MAT) and fibrinolytic (D-dimer) plasmatic systems were evaluated. Von Willebrand factor was also tested.RESULTSPT, APTT, and fibrinogen were within normal limits. High TAT levels were associated with clinical outcome since 16 patients out of 27 (59%) with unfavorable outcomes displayed TAT levels > 20 ngzaq/L, as compared with 10 patients out of 38 (26%) with favorable outcomes. Plasmatic D-dimer, an index of subarachnoid clot lysis, was invariably found to be elevated. Nevertheless, very high levels (> 1000 mcg/mL) were found in 16 patients out of 22 (73%) with unfavorable outcomes but in only 9 patients out of 38 (26%) with favorable outcomes. Significant D-dimer elevation showed a strong association with severe delayed ischemic deficit (DID). Patients were also tested for von Willebrand factor, displaying a specific increase in all cases.CONCLUSIONThe study provides evidence for an early activation of the coagulation and fibrinolytic system following SAH. Increase of plasmatic TAT parallels clinical outcome. A generalized increase of D-dimer was observed as well and D-dimer levels in the high range were associated with clinical outcome and poor results with DID. Our analysis shows close statistical significance between plasma levels of TAT, D-dimer, and outcome. A similar statistical significance has been found when comparing other known prognostic factors such as clinical acid cerebral computerized tomography scan (CT) grade and outcome. (C) 2001 by Elsevier Science Inc.