1978 Volume 9 Issue 2 Pages 243-247
Prevention of rebleeding is one of the most imperative factors in the management of the patients with ruptured intracranial aneurysm. On the basis of an increase in fibrinolytic activity in the cerebrospinal fluid after subarachnoid hemorrhage (SAH), antifibrinolytic therapy has been advocated by many authors, and the results were reported to be satisfactory. On the other hand, little has been known about the changes of the coagulation and fibrinolytic systems in the blood after SAH. The changes in the blood are essential parameters in the administration of antifibrinolytic drugs.
The purpose of this study is to know the changes in the coagulation and fibrinolytic systems of the blood after SAH. Twenty-four patients with ruptured intracranial aneurysm were studied. Thirty-five samples were obtained from the antecubital vein as the sample of the systemic blood and thirteen samples from the internal jugular vein as the sample which was presumed to be under the influence of the intracranial pathology.
Elevation of fibrinogen, factor V and VIII levels, and shortened r and r+k and increased ma values in thrombelastogram were demonstrated in most of the samples. A slight increase in FDP was also proved in most of the samples, but other parameters of fibrinolysis such as plasminogen, plasminogenactivator, alpha-1-antitrypsin and alpha-2-macroglobulin were not changed to any significant degree.
The results apparently indicated a hypercoagulability in the circulating blood in the patients after SAH. The results were also analysed in regard to the length of period after SAH and no significant difference was obtained. There was no particular increase in the fibrinolytic activity in the patients 7 to 21 days after SAH when liability to rebleeding is said to be large. In one patient who bled 4 days after SAH, the coagulation and fibrinolytic activities immediately before the third SAH were all within normal limits in both antecubital and internal jugular blood samples.
Changes of the coagulation and fibrinolytic systems in the internal jugular blood in the patients with SAH were studied in 13 samples from 10 patients. No significant difference was noted between the antecubital and internal jugular blood.
In conclusion, the blood in the patients after SAH showed a hypercoagulability within the period of 2 to 3 weeks after SAH and increase in the fibrinolytic activity was minimal. Accordingly the occurrence of rebleeding was not predicted on the basis of changes of the coagulation and fibrinolytic systems, and no evidence was obtained from this study to support antifibrinolytic therapy in the prevention of rebleeding.
