Early fibrinogen degradation coagulopathy: A predictive factor of parenchymal hematomas in cerebral rt-PA thrombolysis

• Parenchymal hematomas are linked to an early fibrinogen coagulopathy at 2 h.
• Decreased fibrinogen and increased fibrinogen degradation products are observed.
• Fibrinogen less than 2 g/L at 2 h multiplies odds of hematoma by 12.82.

Background and purposeThe purpose of this study was to systematically determine the correlations between the post-thrombolytic changes of hemostasis parameters and the occurrence of early intracerebral hemorrhage (ICH).MethodsIn 72 consecutive patients with cerebral infarcts treated with rt-PA, plasma levels of fibrinogen, plasminogen, alpha2-antiplasmin, factor XIII, fibrin(ogen) degradation products (FDPs) and d-Dimers were measured at baseline, 2 and 24 h after thrombolysis. Correlations were studied between the hemostasis events and early (less than 24 h) hemorrhagic infarcts (HIs) or parenchymatous hematomas (PH).ResultsOf 72 patients, 6 patients (8.3%) had early PHs, 11 (15.3%) had early HIs, and 55 (76.4%) had no bleeding. Early HIs were not linked to any hemostasis parameter at any time. Univariate comparison of patients having early PHs with non-bleeding patients showed hemostasis abnormalities at 2 h: high FDP (p = 0.01), high Log FDP (p = 0.01), low fibrinogen (p = 0.01), and low Log fibrinogen (p = 0.01). Logistic regression adjusted for age, NIHSS and diabetes confirmed these 2 hour predictors: Log FDP (OR: 7.50; CI: 1.26 to 44.61, p = 0.03), and Log fibrinogen (OR: 19.32; CI: 1.81 to 205.98, p = 0.01). The decrease in fibrinogen less than 2 g/L multiplies the odds of early PH by a factor 12.82.ConclusionAn early fibrinogen degradation coagulopathy involving an increase of FDP and a massive consumption of circulating fibrinogen is predictive of early parenchymal hematomas, indicating the occurrence of a particularly intense lysis of circulating fibrinogen. These results, if confirmed by future studies, suggest that early assays of fibrinogen and FDP may be useful in predicting the risk of post-thrombolytic intracerebral hematoma.