Fibrinolytic activity in the CSF and blood following subarachnoid haemorrhage.

Abstract

Fibrinolytic agents are administered to resolve subarachnoid clot, a major reservoir for spasmogen, to prevent delayed cerebral vasospasm (VS) in patients with subarachnoid haemorrhage (SAH). However, intracranial bleeding often occurs, which may be caused by over-activation of fibrinolysis in the cerebrospinal fluid (CSF) milieu. We measured the levels of D dimer in the CSF and blood of patients with SAH to analyse the correlation between fibrinolytic activity and VS. CSF and blood samples were obtained three times, and VS was identified by angiography. The levels of D dimer in the CSF were significantly higher than in the blood, but changes with time were inverse. Patients with VS showed significantly lower levels of D dimer in both CSF and blood in the initial stage compared to those without VS. These observations suggest that monitoring of fibrinolytic activity in the CSF to identify patients eligible for additional fibrinolytic treatment could reduce the risk of VS and iatrogenic intracranial bleeding.