Early fibrinogen degradation coagulopathy: a predictive factor of parenchymal hematomas in cerebral rt-PA thrombolysis

J Neurol Sci. 2015 Apr 15;351(1-2):109-114. doi: 10.1016/j.jns.2015.02.048. Epub 2015 Mar 6.

Abstract

Background and purpose: 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.

Conclusion: 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.

Keywords: 160; 175; 43; 73; Fibrinogen; Fibrinogen degradation products; Hemorrhagic infarcts; Parenchymal hematoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain Infarction / drug therapy*
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / diagnosis*
  • Disseminated Intravascular Coagulation / chemically induced
  • Disseminated Intravascular Coagulation / diagnosis*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Fibrinolytic Agents / adverse effects*
  • Hematoma / chemically induced
  • Hematoma / diagnosis*
  • Hemostasis
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Thrombolytic Therapy / adverse effects*
  • Tissue Plasminogen Activator / adverse effects*

Substances

  • Fibrin Fibrinogen Degradation Products
  • Fibrinolytic Agents
  • Tissue Plasminogen Activator