Abstract
A coagulation-fibrinolytic study was performed on 98 patients with subarachnoid hemorrhage, with reference to severity of subarachnoid hemorrhage and symptomatic vasospasm (S-VS). They were classified in a Grade I & II group (40 patients), a Grade III & IV group (37 patients), and a Grade V group (21 patients) according to their neurological grade (Hunt & Kosnik) at the time of admission.
APTT on the day of onset was shortened in all groups, but particularly so in the III & IV and V groups. Fibrinogen levels were slightly lower in the V group than in the other groups on the day of onset. These levels increased with time in almost all patients. In S-VS cases of the I & II group, the following increase of fibrinogen levels was more remarkable than in cases without S-VS. FDP concentrations were abnormally high in 14%of the I & II group, 42%of the III & IV group, and 56%of V group on the day of onset. The number of cases showing an abnormally high level of FDP increased with time in the III & IV and the V group. Levels of both AT III and prekallikrein were low in the V group on the day of onset. In most cases with S-VS of the I & II and the III & IV groups, AT III levels decreased with time. Platelet counts on the day of onset were within an almost normal range in all groups. They decreased with time and showed the lowest level on Day 4.
On the basis of these data, it seems that the activation of an intrinsic pathway of coagulation is reflected by the severity of subarachnoid hemorrhage, being most enhanced in the V group.
The decrease of AT III level seemed to play an important role in S-VS.
