Early fibrinogen degradation coagulopathy is predictive of parenchymal hematomas in cerebral rt-PA thrombolysis - A study of 157 cases

被引:89
作者
Trouillas, P
Derex, L
Philippeau, F
Nighoghossian, N
Honnorat, J
Hanss, M
Ffrench, P
Adeleine, P
Dechavanne, M
机构
[1] Hop Neurol, Cerebrovasc Unit, F-69003 Lyon, France
[2] Hospices Civils Lyon, Biostat Unit, Lyon, France
[3] Hop Cardiol, Hemostasis Lab, Lyon, France
关键词
hematoma; hemorrhage; fibrinogen; fibrinogen degradation products; thrombolysis;
D O I
10.1161/01.STR.0000126040.99024.cf
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background-Little is known about the coagulation factors as predictors of cerebral bleeding in rt-PA thrombolysis. The aim of this study was to determine what early coagulation parameters could predict early hemorrhagic lesions. Methods-Consecutive patients were included in the Lyon rt-PA protocol. Early hematomas (within 24 hours), diagnosed on an anatomoradiological basis ( symptomatic and not symptomatic) were considered for the study. Fibrinogen and fibrin(ogen) degradation products (FDP) were assessed at entry and at 2 and 24 hours after the beginning of thrombolysis. Results-Of 157 patients, 11 had early parenchymal hematomas (7%), 31 had early hemorrhagic infarcts (19.7%), and 115 had no bleeding (73.2%). In logistic regression, FDP at 2 hours was the single predictor of parenchymal hematomas (OR: 2.5; CI: 1.09 to 5.8), whereas an increase of FDP >200 mg/L multiplied the odds of parenchymal hematoma by 4.95 (IC: 1.09 to 22.4). Early parenchymal hematomas were indicative of a poor prognosis at 3 months (P = 0.001). Conclusions-Early parenchymal hematomas appear as both "malignant" and exclusively related to an explosive increase of FDP at 2 hours, ie, an early fibrinogen degradation coagulopathy (EFDC). All patients scheduled to rt-PA thrombolysis should have an assay of FDP 2 hours after the beginning of thrombolysis: patients with an established EFDC (FDP >200 mg/L) should be monitored specifically, with no antithrombotic drug during the first 72 hours. Patients with FDP >100 mg should share the same monitoring.
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页码:1323 / 1328
页数:6
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