A Correlative Study Of Coagulation,Fibrinolitic System And Cerebral Vasospasm,Rebleeding In Subarachoid Haemorrhage

Objective: To investigate the variation of coagulation and fibrinolitic in the blood, cerebrospinal fluid(CSF), combined with TCD to find out the correlation between coagulation fibrinolitic system and CVS rebleeding. Methods: The peripheral blood samples of 32 SAH patients were collected within 3 days and the 5~th-7~th day and the blood samples of 35 patients excluding SAH as control were collected once. And the CSF samples of 23 SAH patients were collected within 3 days and the 5~th-7~th day and the CSF samples of 29 patients excluding SAH as control were collected once. At the 5~th-7~th day after the onset all the SAH patients were performed TCD examination. Antithrombin III , tissue-type plasminogen activator, plasminogen activator inhibitor and protein C were measured with enzyme-linked immuno-assay. The data were statistically analyzed with SPSS 10.0. The value of P less than 0.05 was considered significant. Results: (1) Compared with the control, the activity levels of PC ATIII PAI t-PA in blood changed significantly within 3 days and the 5~th-7~th day; within 3 days, the activity of PC in blood decreased significantly, and much lower atthe 5~th ~ 7~th day; within 3 days, the activity of ATIII in blood increased significantly, and decreased at the 5~th ~ 7~th day; Plasma PAI activity decreased within 3 days, but increased significantly at the 5~th~7~th day.;The activity levels of Plasma t-PA were increased significantly within 3 days and the 5~th~7~th day,but the 5~th~7~th day decreased greater than within 3 days . PAI/t-PA of the 5~th~7~th day increased greater than within 3 days. (2) Compared with the control, the ATDI and PC activity in CSF increased significantly within 3 days, but decreased at the 5~th~7~th day, however, the activity of ATIII was still much higher than the control; and the PC activity in CSF showed no signicance with the control; PAI activity decreased within 3 days, but increased at the 5~th~7~th day; the activity of Plasma t-PA was increased significantly within 3 days and at the 5~th~7~th day, but the 5~th~7~th day decreased greater than within 3 days, but still increased compared to the control; PAI/t-PA were decreased significantly within 3 days and the 5~th~7~th day, but increased at the 5~th~7~th day compared with that within 3 days. (3 )The blood and CSF levels of PAI-1 were significantly higher in patients with severe SAH than in those with the mild one. While ATDI activity in CSF or blood was much lower in patients with severe SAH than in those with the mild one.Conclution: (1) The variation of coagulation and fibrinolytic system can objectively reflect the severity degree and the prognosis of SAH. (2) At the 5~th~7~th day after SAH, the decrease of the ATDI activity the increase of thePAI activity and the increase of PAI/t-PA were coincidence with CVS, and they can used as CVS predictors. (3) The increase of fibrinolytic activity is one of the major causes of rebleeding in SAH patients treated in internal department with expectant treatment. So antifibrinolytic treatment should last a little longer than patients treated with operation. Because the increase of PAI activity can induce CVS, regularly detection of coagulation and fibrinolytic index may have signicant importance in directing the treatment. (4) To detect the coagulation and fibrinolytic index, and simultaneously examinating patients with TCD can elevate the diagnosis of CVS after SAH.