Activation of Blood Coagulation After Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Trial of Rotational Thromboelastometry.

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) has been reported to actuate blood coagulation. Rotational thromboelastometry (ROTEM) is a dynamic hemostatic test that can differentiate various coagulation abnormalities. For example, increased coagulation activity can be detected as a wider amplitude of tracing (maximal clot firmness [MCF]). ROTEM had not been used to evaluate coagulation changes after aSAH. We evaluated the on-going coagulation process in patients with aSAH in a prospective, observational study to compare their ROTEM assay results with the control values obtained from patients undergoing clipping of nonruptured aneurysms. METHODS: ROTEM analyses were performed at 12, 24, 48, and 72 hours after the onset of aSAH and compared with the preoperative analyses from the control group. A total of 17 patients with aSAH treated in the intensive care unit and 16 control patients were enrolled. RESULTS: At 72 hours, EXTEM-MCF was significantly greater in patients with aSAH compared with the baseline values of the control group (68.0 mm [interquartile range (IQR), 66.0-71.0] versus 64.5 mm [IQR, 59.5-66.8]; P = 0.024). This was mainly due to increased fibrin formation and fibrin polymerization. The same comparison in the FIBTEM-MCF analysis yielded similar results (aSAH group, 23.0 mm [IQR, 19.0-25.0] vs. control group, 15.4 mm [IQR, 12.5-17.8], respectively; P = 0.001). CONCLUSIONS: Blood coagulation is activated at 72 hours after aSAH onset, which can be detected by ROTEM EXTEM-MCF analysis. Also, the FIBTEM-MCF was elevated, implying that the relative contribution of fibrin formation and fibrin polymerization is essential.

Serum S100ß as a prognostic marker in patients with non-traumatic intracranial hemorrhage.

BACKGROUND: The serum concentration of S100ß protein reportedly predicts outcomes after brain injury. We examined the prognostic accuracy of S100ß in patients with non-traumatic intracranial hemorrhage. METHODS: This was a prospective, observational study of patients with non-traumatic intracranial hemorrhage treated in the intensive care unit at our university hospital. Computed tomography imaging findings and the level of consciousness on admission were recorded. Serum S100ß concentration was measured serially during the first six days of admission. Patients with subarachnoid hemorrhage (SAH group) or intracerebral hemorrhage (ICH group) were analyzed separately. The 3-month and 1-year functional outcomes were assessed using the Glasgow Outcome Scale (GOS). RESULTS: Of 108 patients enrolled, 66 were included in the SAH group and 42 in the ICH group. High initial S100ß concentration was associated with Glasgow Coma Score 3-6 on admission (SAH group 0.61 µg/L versus 0.15 µg/L, P=0.001 and ICH group 1.00 µg/L versus 0.42 µg/L, P=0.005). Initial S100ß concentration correlated with ICH volume (rho=0.50, P<0.001) and IVH Sum Score (rho=0.30, P=0.013). The thresholds for the initial S100ß concentration with 100% specificity for poor outcome (GOS 1-3) were 1.40 µg/L for SAH and 1.76 µg/L for ICH group. ORs varied between 3.1 and 6.1 for S100ß on poor outcome in the SAH group. Increasing S100ß level during study period was associated with poor outcome in the SAH group. CONCLUSIONS: Serum S100ß concentration corresponds with the severity of neurological insult and predicts poor outcome in patients with non-traumatic intracranial hemorrhage.