fibrinopeptide-a and Hematoma

To test the hypothesis that an impaired coagulation system facilitates rapid expansion of hypertensive intracerebral hemorrhage (HICH), coagulation markers were assayed in plasma and their relations to both the hemorrhage size and its progressive expansion were analyzed. Ninety patients with HICH were studied. On admission, plasma samples were taken for the coagulation assay. Hematoma volume was calculated from a computed tomography (CT) scan and its enlargement was estimated by comparison to the volume of the hematoma calculated from a second CT scan taken later within 24 hr. Nine out of 90 patients showed enlargement in their hematoma size (enlarged hematoma group). Four of the enlarged hematoma group fell into acute fatal deterioration and died. Plasma levels of both fibrino peptide A (17.2+/-7.8 vs. 4.0+/-0.6 ng/ml, P < 0.05) and thrombin-antithrombin complex (21.9+/-3.1 vs. 7.4+/-2.8 ng/ml, not significant) were higher in the unchanged group than those in the enlarged hematoma group. In the hematoma-enlarged group fibrino-peptide A level did not exceed 10 ng/ml. In the hematoma unchanged group thrombin-AT-III complex values were positively correlated to hematoma volume. Thus, the coagulation system seemed to be highly activated depending on the hemorrhage volume within three hr after ictus in hypertensive intracerebral hemorrhage patients. When thrombin generation was not sufficient after bleeding, the hematoma seemed to be progressively enlarged. In conclusion, plasma levels of the coagulation markers on admission could be useful predictors of the possible enlargement of hematoma which leads to a poor outcome.

Topics: Aged; Aged, 80 and over; Antithrombin III; Blood Coagulation Disorders; Cerebral Hemorrhage; Disease Progression; Female; Fibrinogen; Fibrinopeptide A; Hematoma; Humans; Incidence; Intracranial Hypertension; Male; Middle Aged; Peptide Hydrolases; Platelet Count; Prothrombin Time

Coagulation and fibrinolysis were investigated in 14 claudicants undergoing percutaneous transluminal angioplasty (PTA) for femoropopliteal artery lesions. Cross-linked fibrin degradation products (XL-FDP), tissue plasminogen activator (t-PA) antigen, fibrinopeptide A (FPA), and plasminogen activator inhibitor-1 (PAI-1) activity were measured in peripheral blood. XL-FDP and t-PA increased, and FPA and PAI-1 decreased significantly after angioplasty. XL-FDP increased from baseline 266 +/- 72 ng/ml to 481 +/- 239 ng/ml (p < 0.0005) 30 min after PTA, indicating mural thrombus formation in spite of the significant fall in FPA influenced by heparin. A groin haematoma developed after PTA in 4/6 patients, who received more than 5600 IU heparin and in 1/8 patients receiving smaller dosages. The alterations in PAI-1 showed no correlation with those of t-PA, whereas heparin had a sparing effect on PAI-1 consumption. These findings may indicate that PAI-1 acts as a thrombin inhibitor following deep vessel wall injury by angioplasty. In two patients, who had signs of rethrombosis on the next day, residual FPA was relatively high, XL-FDP peaked at 3530 +/- 1170 ng/ml, and t-PA increased by 2.6 +/- 1.0 ng/ml. The corresponding values in patients with an uncomplicated course were 406 +/- 89 ng/ml (p < 0.0001) and 0.1 +/- 0.5 ng/ml (p < 0.02). We conclude that thrombin promotes activation of coagulation and fibrinolysis in femoropopliteal PTA. Instability between these counteracting systems resulting in thrombosis is not prevented by conventional heparin administration at dosages causing bleeding complications.

Topics: Aged; Angioplasty, Balloon; Blood Coagulation; Female; Femoral Artery; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Fibrinopeptide A; Hematoma; Heparin; Humans; Intermittent Claudication; Male; Middle Aged; Plasminogen Activator Inhibitor 1; Popliteal Artery; Thrombosis; Tissue Plasminogen Activator

Topics: Animals; Blood Coagulation; Cross Reactions; Disease Models, Animal; Fibrinogen; Fibrinopeptide A; Half-Life; Hematoma; Humans; Models, Biological; Radioimmunoassay; Rats; Species Specificity