• T Ebihara, K Kinoshita, A Utagawa, A Sakurai, M Furukawa, Y Kitahata, Y Tominaga, N Chiba, T Moriya, K Nagao, and K Tanjoh.
• Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan. ebi@med.nihon-u.ac.jp
• Acta Neurochir. Suppl. 2006 Jan 1;96:69-73.

ObjectiveTo investigate whether any changes occur in the coagulative/fibrinolytic cascade in patients with subarachnoid hemorrhage (SAH) or hypertensive intracerebral hemorrhage (HICH).Design And MethodsSubjects included 143 patients with intracranial hemorrhage (SAH, n = 50; HICH, n = 82; ROSC-SAH [return of spontaneous circulation after cardiopulmonary arrest due to SAH], n = 11). Coagulative and fibrinolytic factors were measured in blood samples taken on admission.ResultsThe prothrombin fragment 1+2 level was significantly higher (p < 0.005) in SAH patients than in HICH patients. The fibrinolytic factors (plasmin alpha 2-plasmin inhibitor complex, D-dimer, or fibrinogen degradation products) in SAH and ROSC-SAH were both significantly higher than those in HICH, but the significance of difference was stronger in the case of ROSC-SAH (p < 0.05).DiscussionBoth coagulative and fibrinolytic activities were altered after the onset of SAH. These results demonstrate that the coagulative/fibrinolytic cascade might be activated via different mechanisms in different types of stroke. It remains unclear, however, whether a significant alteration of the fibrinolytic cascade in patients with ROSC-SAH might be a nonspecific phenomenon attributable to the reperfusion after collapse.

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