Published Online
on April 22, 2004

A more recent version of this article appeared on June 1, 2004

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Submitted on June 30, 2003
Revised on January 15, 2004
Accepted on February 3, 2004

Early Fibrinogen Degradation Coagulopathy Is Predictive of Parenchymal Hematomas in Cerebral rt-PA Thrombolysis: A Study of 157 Cases

Paul Trouillas MD, PhD^*; Laurent Derex MD; Fréderic Philippeau MD; Norbert Nighoghossian MD; Jerome Honnorat MD; Micel Hanss MD; Patrick Ffrench MD; Patrice Adeleine PhD; and Marc Dechavanne MD

From the Cerebrovascular Unit (P.T., L.D., F.P., N.N., J.H.), Hôpital Neurologique, Lyon, France; the Biostatistical Unit (P.A.), Hospices Civils de Lyon, France; and the Hemostasis Laboratory (M.H., P.F., M.D.), Hôpital Cardiologique, Lyon, France.

^* To whom correspondence should be addressed. E-mail: paul.trouillas{at}chu-lyon.fr.

Background--Little is known about the coagulation factors as predictors of cerebral bleeding in rt-PA thrombolysis. The aim of this study was to determine what early coagulation parameters could predict early hemorrhagic lesions.

Methods--Consecutive patients were included in the Lyon rt-PA protocol. Early hematomas (within 24 hours), diagnosed on an anatomoradiological basis (symptomatic and not symptomatic) were considered for the study. Fibrinogen and fibrin(ogen) degradation products (FDP) were assessed at entry and at 2 and 24 hours after the beginning of thrombolysis.

Results--Of 157 patients, 11 had early parenchymal hematomas (7%), 31 had early hemorrhagic infarcts (19.7%), and 115 had no bleeding (73.2%). In logistic regression, FDP at 2 hours was the single predictor of parenchymal hematomas (OR: 2.5; CI: 1.09 to 5.8), whereas an increase of FDP >200 mg/L multiplied the odds of parenchymal hematoma by 4.95 (IC: 1.09 to 22.4). Early parenchymal hematomas were indicative of a poor prognosis at 3 months (P=0.001).

Conclusions--Early parenchymal hematomas appear as both "malignant" and exclusively related to an explosive increase of FDP at 2 hours, ie, an early fibrinogen degradation coagulopathy (EFDC). All patients scheduled to rt-PA thrombolysis should have an assay of FDP 2 hours after the beginning of thrombolysis: patients with an established EFDC (FDP >200 mg/L) should be monitored specifically, with no antithrombotic drug during the first 72 hours. Patients with FDP >100 mg should share the same monitoring.

Key words: hematoma • hemorrhage • fibrinogen • fibrinogen degradation products • thrombolysis

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