Fibrinolytic activity in CSF of patients with SAH in the acute phase measured by a rapid method (correlation with t-AMCA concentration in CSF.

Abstract

To decide the minimum dose of antifibrinolytic agent for the conservative treatment of subarachnoid hemorrhage (SAH) in the acute phase, we developed a method to measure reduction in fibrinolytic activity of the cerebrospinal fluid (CSF) within a short period of time. It was reproducible and the result was expressed by the t-AMCA score. CSF was collected every 30 minutes or six hours in nine cases of SAH who were treated with an antifibrinolytic agent (t-AMCA) at a daily dose of 4-6 grams and the t-AMCA score obtained was compared with the dosage, t-AMCA concentration in CSF and daily excretion volume of CSF through drainage. The results showed that the concentration of antifibrinolytic agent in CSF was negatively correlated with the daily excretion volume of CSF, and correlated with the dosage when the excretion volume was under 150 ml/day. The t-AMCA score usually changed in a constant pattern which was not related to the concentration of antifibrinolytic agent in CSF. In cases in which treatment was initiated within 48 hours after the hemorrhage, rapid reduction of the fibrinolytic activity in CSF was obtainted within 24 hours after administration, while in one case in which treatment was performed on the 6th day after hemorrhage, a favorable reduction in the fibrinolytic activity could not be obtained until the third day after administration. In a case in which repeated assays were performed in a short period, rebound fibrinolysis was observed two hours after administration and three days after withdrawal.